Genni Lee Miller, LAT, ATC, PTA

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

AT1256 Issued in TX

Practice address

1210 Corinth Rd
Jacksonville, TX 75766-3208

Phone

(903) 586-1704

NPI assigned

Jun 9, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623196800000",
    "number": "1003483777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 COUNTY ROAD 1518",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757666593",
            "telephone_number": "903-724-3232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 CORINTH RD",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757663208",
            "telephone_number": "903-586-1704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "GENNI",
        "middle_name": "LEE",
        "credential": "LAT, ATC, PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-09",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "TX",
            "license": "AT1256",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2076630",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin M McInnis, MD
• Dayna Faith McKey
• Caleb C McMillan, COTA
• Robert Meeks
• William Milawski, MD
• Joyce Valadie Miller
• Chaquarra Lastaysha Mitchell
• Michael Kay Moore, COTA
• Natalie Marie Morgan, FNP-C
• Leslie Anne Moseley, LPC-INTERN, NCC

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Jacksonville, TX
• Providers in Jacksonville, TX by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.