Basic Information
Provider Information
NPI: 1043287246
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLER
FirstName: BRETT
MiddleName: ALAN
NamePrefix:  
NameSuffix:  
Credential: MSPT
OtherOrganizationName:  
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OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
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Mailing Information
Address1: 11481 SW HALL BLVD STE 201
Address2: THERAPEUTIC ASSOCIATES INC
City: PORTLAND
State: OR
PostalCode: 972238403
CountryCode: US
TelephoneNumber: 8002198835
FaxNumber: 5034431402
Practice Location
Address1: 4701 41ST AVE SW STE 100
Address2: TAI - WEST SEATTLE PHYSICAL THERAPY
City: SEATTLE
State: WA
PostalCode: 981164597
CountryCode: US
TelephoneNumber: 2069328363
FaxNumber: 2069324973
Other Information
ProviderEnumerationDate: 03/07/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT00010274WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X20871MDN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000XPT870023DCN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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