Provider Demographics
NPI:1063850592
Name:MILLER, JOHN D (PTA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 FOREST CLUB DR APT 409
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-7909
Mailing Address - Country:US
Mailing Address - Phone:561-396-0675
Mailing Address - Fax:
Practice Address - Street 1:227 SW MONTEREY RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4646
Practice Address - Country:US
Practice Address - Phone:772-781-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23891225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant