Provider Demographics
NPI:1811371057
Name:MILLER, JOSEPH VINCENT (PTA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:VINCENT
Last Name:MILLER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:VINCENT
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:7461
Mailing Address - Street 2:KITTY HAWK DR. APT 13101
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-5277
Mailing Address - Country:US
Mailing Address - Phone:718-812-0422
Mailing Address - Fax:
Practice Address - Street 1:7461 KITTY HAWK APT 13101
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-1699
Practice Address - Country:US
Practice Address - Phone:718-812-0422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007612225200000X
225200000X
MO2015023348225200000X
KS14-02840225200000X
TX2161949225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty