Provider Demographics
NPI:1528814506
Name:MILLER, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 WATER ST
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17368-9124
Mailing Address - Country:US
Mailing Address - Phone:717-968-0282
Mailing Address - Fax:
Practice Address - Street 1:393 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAWN GROVE
Practice Address - State:PA
Practice Address - Zip Code:17321-9514
Practice Address - Country:US
Practice Address - Phone:717-382-4871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer