Provider Demographics
NPI:1023127826
Name:MILLER, DAWN (PT, ATC, MHA)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT, ATC, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12204 REEDPOND CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-4824
Mailing Address - Country:US
Mailing Address - Phone:904-379-3128
Mailing Address - Fax:
Practice Address - Street 1:7749 NORMADY CROSSING
Practice Address - Street 2:SUITE 147
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221
Practice Address - Country:US
Practice Address - Phone:904-786-5576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 18765OtherLICENSE #