Provider Demographics
NPI:1730892316
Name:MILLER, BRIAN (PT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-1820
Mailing Address - Country:US
Mailing Address - Phone:620-376-8632
Mailing Address - Fax:
Practice Address - Street 1:506 3RD ST
Practice Address - Street 2:
Practice Address - City:TRIBUNE
Practice Address - State:KS
Practice Address - Zip Code:67879-9684
Practice Address - Country:US
Practice Address - Phone:620-376-4536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist