Individual
KYZA MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, PTA
Contact information
Practice address
10915 SE STARK ST, PORTLAND, OR 97216-3348
(503) 261-1120
Mailing address
10915 SE STARK ST, PORTLAND, OR 97216-3348
(503) 261-1120
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
9966
OR
Other
Enumeration date
07/14/2021
Last updated
07/14/2021
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