Healthcare Provider Details

I. General information

NPI: 1083740971
Provider Name (Legal Business Name): AMY BETH MARIE MILLER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12127 B-3 NORTH HIGHWAY 14
CEDAR CREST NM
87008
US

IV. Provider business mailing address

208 CALIAS DR
TIJERAS NM
87059-7434
US

V. Phone/Fax

Practice location:
  • Phone: 505-286-3678
  • Fax:
Mailing address:
  • Phone: 505-400-6322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3373
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: