Basic Information
| Provider Information | |||||||||
| NPI: | 1972511053 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC/PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4038 RIDGEFIELD CT | ||||||||
| Address2: | |||||||||
| City: | W LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479065276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654943245 | ||||||||
| FaxNumber: | 7654949899 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 N UNIVERSITY ST # B-63 | ||||||||
| Address2: | PURDUE UNIVERSITY | ||||||||
| City: | W LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479072070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654943245 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 05000723A | IN | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2255A2300X | 36000087A | IN | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.