Healthcare Provider Details

I. General information

NPI: 1992568836
Provider Name (Legal Business Name): KELLEY K MILLER MMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 AUBURN HILLS PKWY STE 604
MCKINNEY TX
75071-3572
US

IV. Provider business mailing address

2001 AUBURN HILLS PKWY STE 604
MCKINNEY TX
75071-3572
US

V. Phone/Fax

Practice location:
  • Phone: 760-846-1442
  • Fax:
Mailing address:
  • Phone: 760-846-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMT128803
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: