Healthcare Provider Details

I. General information

NPI: 1730307695
Provider Name (Legal Business Name): ANN ELIZABETH MILLER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 N CHILLICOTHE ST APT A
PLAIN CITY OH
43064-1048
US

IV. Provider business mailing address

234 N CHILLICOTHE ST APT A
PLAIN CITY OH
43064-1048
US

V. Phone/Fax

Practice location:
  • Phone: 614-873-6049
  • Fax:
Mailing address:
  • Phone: 614-873-6049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.007213
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2491012
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: