Healthcare Provider Details

I. General information

NPI: 1073821302
Provider Name (Legal Business Name): MICHELLE K MILLER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 06/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 MACK AVE
DETROIT MI
48201
US

IV. Provider business mailing address

261 MACK AVE
DETROIT MI
48201-2495
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-1100
  • Fax: 313-745-0476
Mailing address:
  • Phone: 313-745-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010981
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010981
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: