Basic Information
| Provider Information | |||||||||
| NPI: | 1598174377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | GEOFFREY | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17100 N 67TH AVE | ||||||||
| Address2: | BUILDING 100 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853083605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239792747 | ||||||||
| FaxNumber: | 6239793122 | ||||||||
| Practice Location | |||||||||
| Address1: | 17100 N 67TH AVE | ||||||||
| Address2: | BUILDING 100 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853083605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239792747 | ||||||||
| FaxNumber: | 6239793122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2014 | ||||||||
| LastUpdateDate: | 08/15/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11057 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.