Individual provider Active NPI

Andrew Michael Miller, PT

  • Physical Therapist
  • Perrysburg, OH
National Provider Identifier
1700196433
Registry record updated Oct 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT.012961 Issued in OH
Practice address
27511 Holiday LN # 105
Perrysburg, OH 45875
Phone
(419) 796-0303
NPI assigned
Oct 15, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT.012961 OH Primary

Addresses

Primary practice location

27511 Holiday LN # 105
Perrysburg, OH 45875

Mailing address

27511 Holiday LN # 105
Perrysburg, OH 45875

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110218000266 OH Practitioner - Physical Therapist in Private Practice 3779764121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3130 Central Park W
Suite C
Toledo, OH 43617-1088
Phone (419) 720-1290

753 Michigan Ave
Waterville, OH 43566-1052
Phone (567) 342-0688

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT.012961OHMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Complete Care Physical Therapy, LLC CurrentSince Apr 5, 2012 Accepting new patients
Holiday Park Physical Rehabilitation Physical Therapist Past Accepting new patients

Locations

27511 Holiday Ln
Ste 105
Perrysburg, OH 43551
Phone (419) 873-3488

3130 Central Park W
Ste C
Toledo, OH 43617
Phone (419) 720-1290

753 Michigan Ave
Waterville, OH 43566
Phone (419) 441-4251

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1287100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287100800000",
    "number": "1700196433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27511 HOLIDAY LN # 105",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "45875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27511 HOLIDAY LN # 105",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "45875",
            "telephone_number": "419-796-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "ANDREW",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-15",
        "last_updated": "2010-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT.012961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perrysburg, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.