Provider Demographics
NPI:1881933232
Name:MILLER, STACEY B (PT)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:B
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 1:15115 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1857
Mailing Address - Country:US
Mailing Address - Phone:954-682-3755
Mailing Address - Fax:954-437-6648
Practice Address - Street 1:15115 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1857
Practice Address - Country:US
Practice Address - Phone:954-682-3755
Practice Address - Fax:954-437-6648
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist