MEDICARE: MR. RONALD DALE MILLER MPT

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	PT1938	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952352601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD DALE MILLER MPT

Provider Business Mailing Address
First Line	:	7979 W RIFLEMAN ST
Second Line	:	SUITE 100
City	:	BOISE
State	:	ID
Zip	:	83704-9066
Country	:	US
Telephone Number	:	208-377-3850
Fax Number	:	208-658-1360

Provider Business Practice Location Address
First Line	:	7979 W RIFLEMAN ST
Second Line	:	SUITE 100
City	:	BOISE
State	:	ID
Zip	:	83704-9066
Country	:	US
Telephone Number	:	208-377-3850
Fax Number	:	208-658-1360

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/16/2011

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