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General NPI Number Information
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NPI Number | 1326489253
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Entity Type | Individual
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Provider Name | SALLIE CAROLINE MILLER PTA
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Gender | Female
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 12801 N CENTRAL EXPY SUITE 1750
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City | DALLAS
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State | TX
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Zip | 75243-1716
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Country | US
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Telephone | 877-293-6287
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Fax |
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Provider Business Mailing Address
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Address Line | 424 S 23RD ST
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City | BELLEVILLE
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State | IL
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Zip | 62226-7541
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Country | US
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Telephone | 618-960-6904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160002755
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License Number State | IL
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