Healthcare Provider Details

I. General information

NPI: 1598720419
Provider Name (Legal Business Name): CYNTHIA H MILLER MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 ELM ST STE 110
MC LEAN VA
22101
US

IV. Provider business mailing address

2709 NEW AMBLER CT
HERNDON VA
20171
US

V. Phone/Fax

Practice location:
  • Phone: 703-556-4424
  • Fax: 703-556-4435
Mailing address:
  • Phone: 703-733-0529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305202510
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: