Active NPI
Steven Wade Miller, P.T.A.
- Physical Therapy Assistant
- Muskegon, MI
National Provider Identifier
1104028414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA 19321
- Practice address
- 635 W Summit Ave
Muskegon, MI 49441-4190 - Phone
- (231) 830-9030
- NPI assigned
- May 31, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA 19321 | FL | Primary |
Addresses
Primary practice location
635 W Summit Ave
Muskegon, MI 49441-4190
Mailing address
4532 W Kennedy Blvd # 106
Tampa, FL 33609-2042
Phone (813) 690-9914
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA 19321 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104028414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4532 W KENNEDY BLVD # 106",
"city": "TAMPA",
"state": "FL",
"postal_code": "336092042",
"telephone_number": "813-690-9914",
"fax_number": "813-926-9585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "635 W SUMMIT AVE",
"city": "MUSKEGON",
"state": "MI",
"postal_code": "494414190",
"telephone_number": "231-830-9030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "STEVEN",
"middle_name": "WADE",
"credential": "P.T.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "PTA 19321",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muskegon, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.