Healthcare Provider Details

I. General information

NPI: 1215575089
Provider Name (Legal Business Name): NANCY KATHLEEN MILLER PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ANDOVER ST STE 102
NORTH ANDOVER MA
01845-5076
US

IV. Provider business mailing address

401 ANDOVER ST STE 102
NORTH ANDOVER MA
01845-5076
US

V. Phone/Fax

Practice location:
  • Phone: 978-686-0004
  • Fax:
Mailing address:
  • Phone: 978-686-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number7078
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: