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General NPI Number Information
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NPI Number | 1548876469
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Entity Type | Individual
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Provider Name | RYLIE MICHELLE MILLER LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 1910 UNIVERSITY DR
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City | BOISE
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State | ID
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Zip | 83725-0002
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Country | US
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Telephone | 208-426-2403
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Fax | 208-426-2249
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Provider Business Mailing Address
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Address Line | 2106 S DENVER AVE
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City | BOISE
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State | ID
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Zip | 83706-4502
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Country | US
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Telephone | 702-449-8909
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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 | AT-711
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License Number State | ID
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