Healthcare Provider Details

I. General information

NPI: 1548426109
Provider Name (Legal Business Name): MICHELLE ANNETTE MILLER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 MEDI PARK DR
AMARILLO TX
79106-2187
US

IV. Provider business mailing address

3501 S SONCY RD STE 137
AMARILLO TX
79119-6406
US

V. Phone/Fax

Practice location:
  • Phone: 806-457-4700
  • Fax:
Mailing address:
  • Phone: 806-331-6084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1121747
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: