Provider Demographics
NPI:1164230835
Name:MILLER, COLLEEN P (PT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:P
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18360 CONNEAUT LAKE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3735
Mailing Address - Country:US
Mailing Address - Phone:814-460-1348
Mailing Address - Fax:814-333-7001
Practice Address - Street 1:18360 CONNEAUT LAKE RD STE 2
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3735
Practice Address - Country:US
Practice Address - Phone:814-460-1348
Practice Address - Fax:814-333-7001
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007324L2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics