Provider Demographics
NPI:1801223680
Name:MILLER, VANESSA R (DPT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8190 CLEARY BLVD
Mailing Address - Street 2:1904
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1380
Mailing Address - Country:US
Mailing Address - Phone:954-804-7880
Mailing Address - Fax:
Practice Address - Street 1:8190 CLEARY BLVD
Practice Address - Street 2:1904
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1380
Practice Address - Country:US
Practice Address - Phone:954-804-7880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist