Provider Demographics
NPI:1114263670
Name:MILLER, RONALD CHARLES JR (DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CHARLES
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-8406
Mailing Address - Country:US
Mailing Address - Phone:407-494-8835
Mailing Address - Fax:
Practice Address - Street 1:1000 N MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-8406
Practice Address - Country:US
Practice Address - Phone:407-494-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46-1598907OtherEIN