Healthcare Provider Details

I. General information

NPI: 1720505233
Provider Name (Legal Business Name): ALEXIS LINNEE MILLER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 HEALTH DR SW
WYOMING MI
49519-9687
US

IV. Provider business mailing address

286 HOOVER BLVD
HOLLAND MI
49423-3719
US

V. Phone/Fax

Practice location:
  • Phone: 616-333-1200
  • Fax:
Mailing address:
  • Phone: 616-392-2172
  • Fax: 616-392-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501018369
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: