Basic Information
Provider Information
NPI: 1811583990
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLER
FirstName: SHELBY
MiddleName: ELIZABETH
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1829 E FRANKLIN ST STE 600
Address2:  
City: CHAPEL HILL
State: NC
PostalCode: 275145863
CountryCode: US
TelephoneNumber: 9199683456
FaxNumber: 9199323456
Practice Location
Address1: 1829 E FRANKLIN ST STE 600
Address2:  
City: CHAPEL HILL
State: NC
PostalCode: 275145863
CountryCode: US
TelephoneNumber: 9199683456
FaxNumber: 9199323456
Other Information
ProviderEnumerationDate: 12/14/2020
LastUpdateDate: 12/14/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/14/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XP20009NCY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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