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General NPI Number Information
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NPI Number | 1336903681
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Entity Type | Individual
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Provider Name | BRADLEY MILLER ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 10189 N 4800 W
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City | HIGHLAND
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State | UT
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Zip | 84003-8828
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Country | US
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Telephone | 916-823-2952
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Fax |
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Provider Business Mailing Address
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Address Line | 1924 N 840 W
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City | PROVO
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State | UT
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Zip | 84604-1031
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 13457427-4810
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License Number State | UT
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