MEDICARE: MR. FRANK J MIKLOUCICH JR. D.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	027719	NY
2	225100000X	Physical Therapist	027719-1	NY

General Provider Information

NPI Number	:	1053356600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANK J MIKLOUCICH JR. D.P.T.

Provider Business Mailing Address
First Line	:	3060 HENDERSON DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5246
Country	:	US
Telephone Number	:	910-346-3151
Fax Number	:	910-346-2975

Provider Business Practice Location Address
First Line	:	3060 HENDERSON DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5246
Country	:	US
Telephone Number	:	910-346-3151
Fax Number	:	910-346-2975

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	10/09/2014

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Directions to “ MR. FRANK J MIKLOUCICH JR. D.P.T.” Practice Location

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