Provider Demographics
NPI:1659339786
Name:MILLER ORTHOPEDIC AND SPORTS REHAB INC
Entity Type:Organization
Organization Name:MILLER ORTHOPEDIC AND SPORTS REHAB INC
Other - Org Name:MILLER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:561-278-6055
Mailing Address - Street 1:247 SE 6TH AVENUE
Mailing Address - Street 2:UNIT #2
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483
Mailing Address - Country:US
Mailing Address - Phone:561-278-6055
Mailing Address - Fax:561-278-6670
Practice Address - Street 1:247 SE 6TH AVENUE
Practice Address - Street 2:UNIT #2
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483
Practice Address - Country:US
Practice Address - Phone:561-278-6055
Practice Address - Fax:561-278-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9849Medicare PIN