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General NPI Number Information
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NPI Number | 1497455778
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Entity Type | Individual
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Provider Name | ELLESE MILLER
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Gender | Female
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 501 OLD COUNTY RD STE D
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City | BELMONT
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State | CA
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Zip | 94002-2567
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Country | US
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Telephone | 831-359-0924
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Fax |
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Provider Business Mailing Address
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Address Line | 140 VIA SODERINI
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City | APTOS
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State | CA
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Zip | 95003-5845
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 296973
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License Number State | CA
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