Active NPI
Jesse K Miller, BA, PTA
- Physical Therapy Assistant
- Lafayette, IN
National Provider Identifier
1861163529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 06004554A
- Practice address
- 5165 McCarty LN
Lafayette, IN 47905-8764 - Phone
- (765) 448-8000
- NPI assigned
- Sep 22, 2021
- Sex
- Male
- 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 Therapy Assistant | 225200000X | 06004554A | IN | Primary |
Addresses
Primary practice location
5165 McCarty LN
Lafayette, IN 47905-8764
Mailing address
925 S East St
Crown Point, IN 46307-4908
Phone (812) 595-5759
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
- Credentials
- Bachelor of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06004554A | IN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695600000000",
"number": "1861163529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "925 S EAST ST",
"city": "CROWN POINT",
"state": "IN",
"postal_code": "463074908",
"telephone_number": "812-595-5759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5165 MCCARTY LN",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479058764",
"telephone_number": "765-448-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "JESSE",
"middle_name": "K",
"credential": "BA, PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-22",
"last_updated": "2023-09-25",
"certification_date": "2023-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "06004554A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.