Healthcare Provider Details

I. General information

NPI: 1720019599
Provider Name (Legal Business Name): SCOTT T MILLER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6016 LOVERS LN
PORTAGE MI
49002-3050
US

IV. Provider business mailing address

13331 PARK WEST BLVD
VICKSBURG MI
49097-8494
US

V. Phone/Fax

Practice location:
  • Phone: 269-329-0934
  • Fax: 269-329-0965
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501009456
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: