MEDICARE: STACI L MILLER PT

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	033085-1	NY
2	225100000X	Physical Therapist	0400003599	VT
3	225100000X	Physical Therapist	11833	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11346086	OTHER		CIGNA
2	11346086	OTHER		GREAT WEST
3	00068157	OTHER	VT	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	373056	OTHER		MVP HEALTHCARE

General Provider Information

NPI Number	:	1467562900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACI L MILLER PT

Provider Business Mailing Address
First Line	:	5113 PIPER STATION DR
Second Line	:	SUITE 202
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6689
Country	:	US
Telephone Number	:	980-224-8191
Fax Number	:	980-224-8194

Provider Business Practice Location Address
First Line	:	5113 PIPER STATION DR
Second Line	:	SUITE 202
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6689
Country	:	US
Telephone Number	:	980-224-8191
Fax Number	:	980-224-8194

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/18/2011

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Directions to “ STACI L MILLER PT” Practice Location

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