Provider Demographics
NPI:1679922124
Name:MILLER, COLLEEN (DPT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3735 86TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4008
Mailing Address - Country:US
Mailing Address - Phone:515-985-7530
Mailing Address - Fax:515-985-7531
Practice Address - Street 1:3735 86TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4008
Practice Address - Country:US
Practice Address - Phone:515-985-7530
Practice Address - Fax:515-985-7531
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist