MEDICARE: MADISON 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

General Provider Information

NPI Number	:	1528814506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON MILLER

Provider Business Mailing Address
First Line	:	1059 WATER ST
Second Line	:
City	:	WRIGHTSVILLE
State	:	PA
Zip	:	17368-9124
Country	:	US
Telephone Number	:	717-968-0282
Fax Number	:

Provider Business Practice Location Address
First Line	:	393 MAIN ST
Second Line	:
City	:	FAWN GROVE
State	:	PA
Zip	:	17321-9514
Country	:	US
Telephone Number	:	717-382-4871
Fax Number	:

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

Provider Enumeration Date	:	04/29/2024
Last Update Date	:	04/29/2025

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Directions to “ MADISON MILLER ” Practice Location

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