Basic Information
| Provider Information | |||||||||
| NPI: | 1194907030 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 GARDEN VIEW CT | ||||||||
| Address2: | STE 103 | ||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920242478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606326942 | ||||||||
| FaxNumber: | 7606326670 | ||||||||
| Practice Location | |||||||||
| Address1: | 7760 EL CAMINO REAL | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920098553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606349750 | ||||||||
| FaxNumber: | 7606349752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2007 | ||||||||
| LastUpdateDate: | 02/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT34268 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.