Healthcare Provider Details

I. General information

NPI: 1225319163
Provider Name (Legal Business Name): REBECCA LYDIA MILLER MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MARKET ST NE SUITE 108
OLYMPIA WA
98501-1008
US

IV. Provider business mailing address

1519 132ND ST SE SUITE A
EVERETT WA
98208-7203
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-7085
  • Fax: 360-357-3671
Mailing address:
  • Phone: 425-357-9380
  • Fax: 425-357-9382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 60242571
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: