Healthcare Provider Details

I. General information

NPI: 1134185440
Provider Name (Legal Business Name): MARISA C. MILLER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S DAVY CROCKETT PKWY
MORRISTOWN TN
37813-1908
US

IV. Provider business mailing address

500 S DAVY CROCKETT PKWY
MORRISTOWN TN
37813-1908
US

V. Phone/Fax

Practice location:
  • Phone: 423-318-2722
  • Fax:
Mailing address:
  • Phone: 423-318-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT007399
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7532
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: