MEDICARE: JANET MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	B-013918	UT

General Provider Information

NPI Number	:	1194230722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET MILLER

Provider Business Mailing Address
First Line	:	2129 TWILIGHT CT
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-7001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1612 UTE BLVD STE 210
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-7503
Country	:	US
Telephone Number	:	435-640-5610
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	03/17/2018

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