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General NPI Number Information
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NPI Number | 1457952509
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Entity Type | Individual
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Provider Name | STEPHANIE MILLER PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 313 FURYS FERRY RD
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City | MARTINEZ
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State | GA
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Zip | 30907-3001
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Country | US
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Telephone | 706-955-2275
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Fax |
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Provider Business Mailing Address
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Address Line | 1690 ROSE MOSS CT SE
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City | SMYRNA
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State | GA
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Zip | 30082-3969
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | PT015035
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License Number State | GA
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