Provider Demographics
NPI:1669672226
Name:MILLER, JOHN F (MSPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:F
Last Name:MILLER
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12409 AVON LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-7143
Mailing Address - Country:US
Mailing Address - Phone:804-594-0468
Mailing Address - Fax:804-594-0469
Practice Address - Street 1:12409 AVON LAKE CIR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-7143
Practice Address - Country:US
Practice Address - Phone:804-594-0468
Practice Address - Fax:804-594-0469
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004325225100000X
WI5096-024225100000X
VA2305203837225100000X
MI4801004349376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No376G00000XNursing Service Related ProvidersNursing Home Administrator