Provider Demographics
NPI:1164742169
Name:MILLER, SALLY JO (LMT,NCBTMB,FS)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMT,NCBTMB,FS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2855
Mailing Address - Country:US
Mailing Address - Phone:321-698-1220
Mailing Address - Fax:
Practice Address - Street 1:1345 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2855
Practice Address - Country:US
Practice Address - Phone:321-698-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-31047225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist