Provider Demographics
NPI:1780775155
Name:MILLER, MATTHEW R (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:MILLER
Suffix:
Gender:M
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 1703
Mailing Address - Street 2:
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719
Mailing Address - Country:US
Mailing Address - Phone:732-681-1122
Mailing Address - Fax:732-681-0999
Practice Address - Street 1:2510 BELMAR BLVD
Practice Address - Street 2:COLFAX PLAZA
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3948
Practice Address - Country:US
Practice Address - Phone:732-681-1122
Practice Address - Fax:732-681-0999
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00464800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist