Provider Demographics
NPI:1013187095
Name:MILLER, JEFFREY KENNETH (DPT, MOT)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KENNETH
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPT, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13557 WATERHOUSE WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8340
Mailing Address - Country:US
Mailing Address - Phone:407-579-1005
Mailing Address - Fax:
Practice Address - Street 1:652 PALM SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7841
Practice Address - Country:US
Practice Address - Phone:407-389-1092
Practice Address - Fax:407-389-1097
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12648225X00000X
FL240862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist