Provider Demographics
NPI:1568670644
Name:MILLER, JOAN (PT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
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 7504
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33807-7504
Mailing Address - Country:US
Mailing Address - Phone:863-644-7330
Mailing Address - Fax:863-619-8764
Practice Address - Street 1:3020 S FLORIDA AVE
Practice Address - Street 2:ABBEY BUSINESS PARK, STE 321-B
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4053
Practice Address - Country:US
Practice Address - Phone:863-644-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTFL40752251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic