Provider Demographics
NPI:1275299026
Name:MILLER, THOMAS JAMES (PT, DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22521 AVENIDA EMPRESA STE 116
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2046
Mailing Address - Country:US
Mailing Address - Phone:949-766-8535
Mailing Address - Fax:
Practice Address - Street 1:22521 AVENIDA EMPRESA STE 116
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2046
Practice Address - Country:US
Practice Address - Phone:949-766-8535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT300969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist