Active NPI
Kelly Anne Miller, LPT
- Physical Therapist
- Philadelphia, PA
National Provider Identifier
1609199363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT020411
- Practice address
- 3600 Grant Ave
Philadelphia, PA 19114-1528 - Phone
- (215) 677-0400
- NPI assigned
- Mar 10, 2010
- 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 | PT020411 | PA | Primary |
Addresses
Primary practice location
3600 Grant Ave
Philadelphia, PA 19114-1528
Mailing address
3600 Grant Ave
Philadelphia, PA 19114-1528
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2154416 | Other | PA | PA BLUE SHIELD |
| 3769514000 | Other | PA | IBC |
| 102532415-0001 | Medicaid | PA |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT020411 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346976000000",
"number": "1609199363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3600 GRANT AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191141528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 GRANT AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191141528",
"telephone_number": "215-677-0400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "KELLY",
"middle_name": "ANNE",
"credential": "LPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-10",
"last_updated": "2012-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT020411",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA BLUE SHIELD",
"identifier": "2154416",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IBC",
"identifier": "3769514000",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102532415-0001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 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.