MEDICARE: MRS. KIMBERLY WEBER 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	10625-024	WI

General Provider Information

NPI Number	:	1578587689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY WEBER MILLER PT

Provider Business Mailing Address
First Line	:	N119W15491 DANIELS DR
Second Line	:
City	:	GERMANTOWN
State	:	WI
Zip	:	53022-2000
Country	:	US
Telephone Number	:	262-432-0265
Fax Number	:

Provider Business Practice Location Address
First Line	:	12600 N PORT WASHINGTON RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-3469
Country	:	US
Telephone Number	:	262-381-8830
Fax Number	:

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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