Provider Demographics
NPI:1780924324
Name:MILLER, SANDRA L (PT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HORICON DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3316
Mailing Address - Country:US
Mailing Address - Phone:732-493-4223
Mailing Address - Fax:
Practice Address - Street 1:14 BRIDGEWATERS DR
Practice Address - Street 2:SUITE A
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1162
Practice Address - Country:US
Practice Address - Phone:732-542-6600
Practice Address - Fax:732-542-6606
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA008209002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics