Provider Demographics
NPI:1356556278
Name:MILLER, GREGORY BRUCE (PT)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:BRUCE
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:256 NOKOMIS AVE S
Mailing Address - Street 2:STE. 2
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2357
Mailing Address - Country:US
Mailing Address - Phone:941-484-1939
Mailing Address - Fax:941-484-7804
Practice Address - Street 1:256 NOKOMIS AVE S
Practice Address - Street 2:STE. 2
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2357
Practice Address - Country:US
Practice Address - Phone:941-484-1939
Practice Address - Fax:941-484-7804
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4496768OtherAETNA
FLQ08OtherBCBS OF FLORIDA
FLQ08OtherBCBS OF FLORIDA