MEDICARE: MS. JESSICA MARIE MILLER DPT

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	2011020654	MO

General Provider Information

NPI Number	:	1770871063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA MARIE MILLER DPT

Provider Business Mailing Address
First Line	:	2 HARBOR BEND CT
Second Line	:
City	:	LAKE SAINT LOUIS
State	:	MO
Zip	:	63367-1478
Country	:	US
Telephone Number	:	636-697-6964
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 HARBOR BEND CT
Second Line	:
City	:	LAKE SAINT LOUIS
State	:	MO
Zip	:	63367-1478
Country	:	US
Telephone Number	:	636-697-6964
Fax Number	:

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

Provider Enumeration Date	:	07/20/2011
Last Update Date	:	07/20/2011

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