Provider Demographics
NPI:1275811960
Name:MACIAS, MILTON K (PT, DPT, COMT)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:K
Last Name:MACIAS
Suffix:
Gender:M
Credentials:PT, DPT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19651 BRUCE B DOWNS BLVD STE D2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3430
Mailing Address - Country:US
Mailing Address - Phone:813-991-7193
Mailing Address - Fax:813-991-7459
Practice Address - Street 1:19651 BRUCE B DOWNS BLVD STE D2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3430
Practice Address - Country:US
Practice Address - Phone:813-991-7193
Practice Address - Fax:813-991-7459
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist