Provider Demographics
NPI:1174535645
Name:MILLER, GARY DEAN (PT, CPED)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:DEAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047
Mailing Address - Country:US
Mailing Address - Phone:406-222-4682
Mailing Address - Fax:406-222-4681
Practice Address - Street 1:315 S. MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047
Practice Address - Country:US
Practice Address - Phone:406-222-4682
Practice Address - Fax:406-222-4681
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2442225100000X
224L00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT67922Medicare ID - Type Unspecified
AKK153331Medicare ID - Type Unspecified