Provider Demographics
NPI:1881766772
Name:MILLER, DAVID S (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
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 1:8073 WASHINGTON VILLAGE DR
Mailing Address - Street 2:STE 110
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1847
Mailing Address - Country:US
Mailing Address - Phone:937-813-8052
Mailing Address - Fax:937-813-8056
Practice Address - Street 1:8073 WASHINGTON VILLAGE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1847
Practice Address - Country:US
Practice Address - Phone:859-268-1201
Practice Address - Fax:859-268-1202
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT08560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108341Medicaid
OH000000190966OtherBC/BS
OH382617193-30OtherBWC
OH382617193-30OtherBWC