=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457965741
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JARETT LEE MILLER PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2020
-----------------------------------------------------
Last Update Date | 04/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 775 LAFAYETTE RD
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801-7400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-431-9700
-----------------------------------------------------
Fax | 603-431-9701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 73 NEWTON RD UNIT 101
-----------------------------------------------------
City | PLAISTOW
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03865-2440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-388-7272
-----------------------------------------------------
Fax | 978-388-7373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 4699
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------