Provider Demographics
NPI:1326547654
Name:MILLER, JOSHUA (PTA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
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 1:2783 SW 87TH DR STE 102
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-9375
Mailing Address - Country:US
Mailing Address - Phone:352-505-6665
Mailing Address - Fax:352-226-8744
Practice Address - Street 1:2783 SW 87TH DR STE 102
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-9375
Practice Address - Country:US
Practice Address - Phone:352-505-6665
Practice Address - Fax:352-226-8744
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA28248225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA28248OtherPHYSICAL THERAPY ASSISTANT