Provider Demographics
NPI:1245960111
Name:MILETICH, ANASTASIA RAY (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:RAY
Last Name:MILETICH
Suffix:
Gender:F
Credentials:PT, DPT
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 356
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-0356
Mailing Address - Country:US
Mailing Address - Phone:301-263-3670
Mailing Address - Fax:301-500-2175
Practice Address - Street 1:8737 COLESVILLE RD STE 502
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3928
Practice Address - Country:US
Practice Address - Phone:301-273-3672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD28975OtherSTATE LICENSE