Provider Demographics
NPI:1346617040
Name:MILLIGAN, BOBBIE LEE (PTA19113)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:LEE
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:PTA19113
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 MUDDY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4895
Mailing Address - Country:US
Mailing Address - Phone:386-265-4493
Mailing Address - Fax:
Practice Address - Street 1:384 MUDDY CREEK LN
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4895
Practice Address - Country:US
Practice Address - Phone:386-265-4493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19113225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant