MEDICARE: PROF. DIANE WINNER 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	225200000X	Physical Therapy Assistant	2409	NC

General Provider Information

NPI Number	:	1609898949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. DIANE WINNER MILLER

Provider Business Mailing Address
First Line	:	236 EARLIE COLLINS RD
Second Line	:
City	:	CASTALIA
State	:	NC
Zip	:	27816-9111
Country	:	US
Telephone Number	:	919-853-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 N BICKETT BLVD STE E
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-2178
Country	:	US
Telephone Number	:	919-497-8414
Fax Number	:

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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