Provider Demographics
NPI:1477834836
Name:MILLER, TIMOTHY PEARCE (DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PEARCE
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-974-8613
Mailing Address - Fax:813-974-8614
Practice Address - Street 1:13330 USF LAUREL DR
Practice Address - Street 2:MDC90
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6601
Practice Address - Country:US
Practice Address - Phone:813-974-8613
Practice Address - Fax:813-974-8614
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY08USOtherBLUE CROSS BLUE SHIELD
FL004031800Medicaid
FL004031800Medicaid