MEDICARE: MATTHEW N 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	1263	NE
2	225100000X	Physical Therapist	PT60129938	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	258661	OTHER	WA	L & I
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700812377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW N MILLER PT

Provider Business Mailing Address
First Line	:	700 NE 87TH AVE
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1913
Country	:	US
Telephone Number	:	360-882-2778
Fax Number	:	360-604-1762

Provider Business Practice Location Address
First Line	:	2005 W MAIN ST
Second Line	:
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-4311
Country	:	US
Telephone Number	:	360-882-2778
Fax Number	:	360-604-1762

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

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	09/28/2010

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