Healthcare Provider Details

I. General information

NPI: 1114016540
Provider Name (Legal Business Name): TIMOTHY CLARENCE MILLER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 STATE ST STE 10
NEW ALBANY IN
47150-4962
US

IV. Provider business mailing address

2441 STATE ST STE 10
NEW ALBANY IN
47150-4962
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-4500
  • Fax: 812-945-4808
Mailing address:
  • Phone: 812-945-4500
  • Fax: 812-945-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05005346A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: