Provider Demographics
NPI:1871077396
Name:MILLER, SAMANTHA GENE (DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:GENE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 E GRAND RIVER AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4300
Mailing Address - Country:US
Mailing Address - Phone:517-364-8695
Mailing Address - Fax:517-364-8696
Practice Address - Street 1:2909 E GRAND RIVER AVE STE 301
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4300
Practice Address - Country:US
Practice Address - Phone:517-364-8695
Practice Address - Fax:517-364-8696
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist