Healthcare Provider Details

I. General information

NPI: 1356339899
Provider Name (Legal Business Name): CHRISTY MILLER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4138 19TH ST
LUBBOCK TX
79407-2403
US

IV. Provider business mailing address

4138 19TH ST
LUBBOCK TX
79407-2403
US

V. Phone/Fax

Practice location:
  • Phone: 806-780-2329
  • Fax: 806-780-2330
Mailing address:
  • Phone: 806-780-2329
  • Fax: 806-780-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2036655
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: