MEDICARE: CAROLYN-RENEE 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
2	225100000X	Physical Therapist	21498	MD

General Provider Information

NPI Number	:	1639232846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN-RENEE MILLER PT

Provider Business Mailing Address
First Line	:	1 PEPPERELL CT
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-4663
Country	:	US
Telephone Number	:	202-246-2711
Fax Number	:

Provider Business Practice Location Address
First Line	:	13247 EXECUTIVE PARK TER
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-2648
Country	:	US
Telephone Number	:	703-645-0290
Fax Number	:

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	01/30/2024

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