MEDICARE: MICHAEL 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	007405	OTHER	CT	LICENSE

General Provider Information

NPI Number	:	1427167246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MILLER

Provider Business Mailing Address
First Line	:	563 GOFF RD
Second Line	:
City	:	WETHERSFIELD
State	:	CT
Zip	:	06109-2106
Country	:	US
Telephone Number	:	203-641-8431
Fax Number	:

Provider Business Practice Location Address
First Line	:	893 MAIN STREET SUITE 302
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-3228
Country	:	US
Telephone Number	:	860-289-6021
Fax Number	:

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	11/13/2008

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Directions to “ MICHAEL MILLER ” Practice Location

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