MEDICARE: KATRINA 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	2404	OK
2	225100000X	Physical Therapist	PT 2404	OK

General Provider Information

NPI Number	:	1912188863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA MILLER PT

Provider Business Mailing Address
First Line	:	2232 W HOUSTON ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-3529
Country	:	US
Telephone Number	:	918-259-9522
Fax Number	:	918-259-9521

Provider Business Practice Location Address
First Line	:	1609 N STRONG BLVD
Second Line	:
City	:	MCALESTER
State	:	OK
Zip	:	74501-3839
Country	:	US
Telephone Number	:	918-756-6060
Fax Number	:	918-756-6058

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

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	06/21/2022

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Directions to “ KATRINA MILLER PT” Practice Location

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