Basic Information
| Provider Information | |||||||||
| NPI: | 1881766772 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8073 WASHINGTON VILLAGE DR | ||||||||
| Address2: | STE 110 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454581847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9378138052 | ||||||||
| FaxNumber: | 9378138056 | ||||||||
| Practice Location | |||||||||
| Address1: | 8073 WASHINGTON VILLAGE DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454581847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592681201 | ||||||||
| FaxNumber: | 8592681202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 03/22/2016 | ||||||||
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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 | PT08560 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0108341 | 05 | OH | MEDICAID | 000000190966 | 01 | OH | BC/BS | OTHER | 382617193-30 | 01 | OH | BWC | OTHER |