MEDICARE: CLARENCE 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	225100000X	Physical Therapist	004117	KY
2	225100000X	Physical Therapist	5247	SC
3	225100000X	Physical Therapist	2335	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396707626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARENCE MILLER

Provider Business Mailing Address
First Line	:	848 N RAINBOW BLVD # 357
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1103
Country	:	US
Telephone Number	:	702-256-9738
Fax Number	:	702-242-5629

Provider Business Practice Location Address
First Line	:	600 S RANCHO DR STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4806
Country	:	US
Telephone Number	:	702-258-9381
Fax Number	:	702-258-9584

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	07/20/2009

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Directions to “ CLARENCE MILLER ” Practice Location

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