Provider Demographics
NPI:1447292453
Name:MILLER, LANCE M (PT)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:M
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 1:6015 S 240TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-3406
Mailing Address - Country:US
Mailing Address - Phone:253-852-4587
Mailing Address - Fax:253-859-3962
Practice Address - Street 1:6015 S 240TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-3406
Practice Address - Country:US
Practice Address - Phone:253-852-4587
Practice Address - Fax:253-859-3962
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8931866OtherL&I CRIME VICTIMS
WAP00034707OtherRAILROAD MEDICARE
WA7930039OtherAETNA
WA8335895Medicaid
WA0223987OtherDEPT. OF LABOR & INDUSTRY
WA4788MIOtherREGENCE BLUE SHIELD
WA470930529-98201-A013OtherTRICARE
WAG8800864Medicare PIN