Provider Demographics
NPI:1578645578
Name:MILLER, JOHN ROY (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROY
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 CYPRESS CR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039
Mailing Address - Country:US
Mailing Address - Phone:817-545-7500
Mailing Address - Fax:817-545-9793
Practice Address - Street 1:2901-B MARTIN DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-3839
Practice Address - Country:US
Practice Address - Phone:817-545-7500
Practice Address - Fax:817-545-9793
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist