Provider Demographics
NPI:1134549371
Name:MILLER, GARY (MPT)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4238 FOX RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-4003
Mailing Address - Country:US
Mailing Address - Phone:954-592-4949
Mailing Address - Fax:
Practice Address - Street 1:4238 FOX RIDGE DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-4003
Practice Address - Country:US
Practice Address - Phone:954-592-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist