Provider Demographics
NPI:1871903286
Name:MILLER, JENNIFER (MPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MILLER
Suffix:
Gender:
Credentials:MPT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:REID
Other - Last Name:NORDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4626 WILLOW RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8517
Mailing Address - Country:US
Mailing Address - Phone:925-463-0470
Mailing Address - Fax:925-463-0473
Practice Address - Street 1:4626 WILLOW RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8517
Practice Address - Country:US
Practice Address - Phone:925-463-0470
Practice Address - Fax:925-463-0473
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 23429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 23429OtherMEDICAL LICENSE