Provider Demographics
NPI:1144495557
Name:ROBERT WAYNE MILLER II
Entity type:Organization
Organization Name:ROBERT WAYNE MILLER II
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:928-214-7303
Mailing Address - Street 1:515 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3042
Mailing Address - Country:US
Mailing Address - Phone:928-214-7303
Mailing Address - Fax:928-214-0696
Practice Address - Street 1:515 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3042
Practice Address - Country:US
Practice Address - Phone:928-214-7303
Practice Address - Fax:928-214-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6213261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ128598Medicare PIN