MEDICARE: MR. MICHAEL WAYNE MILLER P.T.

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	5010	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7725454	OTHER	AZ	AETNA
2	AZ0401980	OTHER	AZ	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1851393037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL WAYNE MILLER P.T.

Provider Business Mailing Address
First Line	:	4545 N KIRKWOOD AVE
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-9239
Country	:	US
Telephone Number	:	480-227-1240
Fax Number	:	623-934-3887

Provider Business Practice Location Address
First Line	:	950 E RIGGS RD
Second Line	:	STE 1
City	:	CHANDLER
State	:	AZ
Zip	:	85249-5399
Country	:	US
Telephone Number	:	480-802-0730
Fax Number	:	480-802-8739

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/01/2012

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