Provider Demographics
NPI:1053957050
Name:MILLER, JASMINE SYIN-LAN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:SYIN-LAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8089 WILD LEMON LN
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9792
Mailing Address - Country:US
Mailing Address - Phone:315-559-5317
Mailing Address - Fax:
Practice Address - Street 1:1301 E COLVIN ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13244-4403
Practice Address - Country:US
Practice Address - Phone:315-559-5317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
IN36003514A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN36003514AOtherINDIANA AT LICENSE
2000042441OtherBOC CERTIFIATION
300263OtherNATA MEMBER NUMBER