MEDICARE: MRS. NICOLE ANN 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	5501008068	MI

General Provider Information

NPI Number	:	1942455324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE ANN MILLER P.T.

Provider Business Mailing Address
First Line	:	3205 GOLDENEYE LN
Second Line	:
City	:	WOLVERINE LAKE
State	:	MI
Zip	:	48390-5459
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5336 KRISTI LN
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-3358
Country	:	US
Telephone Number	:	248-860-2542
Fax Number	:

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

Provider Enumeration Date	:	11/26/2008
Last Update Date	:	07/27/2022

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