Active NPI
Jenna Leeann Miller, PT, DPT, ATC, CLT
- Physical Therapist
- Raleigh, NC
National Provider Identifier
1295096683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11660
- Practice address
- 2626 Glenwood Ave
Suite 160
Raleigh, NC 27608-1043 - Phone
- (877) 781-9565
- NPI assigned
- Jun 2, 2012
- Sex
- Female
- Sole proprietor
- No
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 Therapist | 225100000X | 11660 | NC | Primary |
Addresses
Primary practice location
2626 Glenwood Ave
Suite 160
Raleigh, NC 27608-1043
Mailing address
17 Maybury CT
Arden, NC 28704-2940
Phone (812) 528-0590
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 |
|---|---|---|---|
| 11660 | NC | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338595200000",
"number": "1295096683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 MAYBURY CT",
"city": "ARDEN",
"state": "NC",
"postal_code": "287042940",
"telephone_number": "812-528-0590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2626 GLENWOOD AVE",
"address_2": "SUITE 160",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276081043",
"telephone_number": "877-781-9565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "JENNA",
"middle_name": "LEEANN",
"credential": "PT, DPT, ATC, CLT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-02",
"last_updated": "2012-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "11660",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.