Provider Demographics
NPI:1104028414
Name:MILLER, STEVEN WADE (PTA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WADE
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 1:4532 W KENNEDY BLVD # 106
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2042
Mailing Address - Country:US
Mailing Address - Phone:813-690-9914
Mailing Address - Fax:813-926-9585
Practice Address - Street 1:635 W SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4190
Practice Address - Country:US
Practice Address - Phone:231-830-9030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 19321225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant