Basic Information
| Provider Information | |||||||||
| NPI: | 1669527024 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HARTZELL | ||||||||
| OtherFirstName: | JAMIE | ||||||||
| OtherMiddleName: | R | ||||||||
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| OtherCredential: | PT, DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4715 N 32ND ST | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850183300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806895520 | ||||||||
| FaxNumber: | 4807067409 | ||||||||
| Practice Location | |||||||||
| Address1: | 7707 W DEER VALLEY RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853822101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6233769100 | ||||||||
| FaxNumber: | 6233769141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 04/11/2014 | ||||||||
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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 | 7320 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251X0800X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 2251S0007X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
No ID Information.