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Individual
KELLY ANNE MILLER
Active
Individual
KELLY ANNE MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT020411
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102532415-0001
—
PA
01
—
2154416
PA BLUE SHIELD
PA
01
—
3769514000
IBC
PA
Enumeration date
03/10/2010
Last updated
09/07/2012
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