Healthcare Provider Details

I. General information

NPI: 1003865379
Provider Name (Legal Business Name): COLLEEN ANN MILLER LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 LOMBARDO CTR
SEVEN HILLS OH
44131-2540
US

IV. Provider business mailing address

7708 RANETT AVE
HUDSON OH
44236-1447
US

V. Phone/Fax

Practice location:
  • Phone: 216-447-1149
  • Fax:
Mailing address:
  • Phone: 330-656-9799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number003
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: