Provider Demographics
NPI:1710977418
Name:MILLER, KATHLEEN KAY (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:KAY
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 1:777 S PALM AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-7770
Mailing Address - Country:US
Mailing Address - Phone:941-330-1677
Mailing Address - Fax:
Practice Address - Street 1:777 S PALM AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7770
Practice Address - Country:US
Practice Address - Phone:941-330-1677
Practice Address - Fax:941-330-1688
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist