Provider Demographics
NPI:1548247224
Name:MILLER, LEE GARRETT (PT)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:GARRETT
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:441 MOOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3627
Mailing Address - Country:US
Mailing Address - Phone:337-457-8164
Mailing Address - Fax:337-546-6515
Practice Address - Street 1:441 MOOSA BLVD
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3627
Practice Address - Country:US
Practice Address - Phone:337-457-8164
Practice Address - Fax:337-546-6515
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1019437Medicaid
LA1409146Medicaid
LAAH689C892Medicare PIN