Provider Demographics
NPI:1841412095
Name:MILLER, JEFF PAUL (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:PAUL
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 1:460 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2535
Mailing Address - Country:US
Mailing Address - Phone:805-473-0555
Mailing Address - Fax:888-572-9170
Practice Address - Street 1:750 FARROLL RD STE A
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2654
Practice Address - Country:US
Practice Address - Phone:805-473-0555
Practice Address - Fax:888-572-9170
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 24124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist