Provider Demographics
NPI:1811189228
Name:MILLER, THOMAS A (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
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 2010
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-8010
Mailing Address - Country:US
Mailing Address - Phone:850-682-7466
Mailing Address - Fax:850-682-6591
Practice Address - Street 1:577 BROOKMEADE DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-6029
Practice Address - Country:US
Practice Address - Phone:850-682-7466
Practice Address - Fax:850-682-6591
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0002988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY902QOtherBLUE CROSS BLUE SHIELD
FLPT0002988OtherSTATE LICENSE
FLK0739Medicare PIN