Provider Demographics
NPI:1578752515
Name:MILLER, MOLLY ALIZABETH (PT)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:ALIZABETH
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 7066
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33673-7066
Mailing Address - Country:US
Mailing Address - Phone:813-237-0777
Mailing Address - Fax:813-237-2999
Practice Address - Street 1:5701 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-6913
Practice Address - Country:US
Practice Address - Phone:813-237-0777
Practice Address - Fax:813-237-2999
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0013284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8055OtherBLUE CROSS BLUE SHIELD
FLY8055AMedicare PIN