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NPI Code Detail

MEDICARE: MOLLY A. MILLER, MS, PT, LMT

MEDICARE: MOLLY A. MILLER, MS, PT, LMT
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
1225100000XPhysical TherapistPT0013284FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Y8055OTHERFLBLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number : 1053577684
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOLLY A. MILLER, MS, PT, LMT
Provider Business Mailing Address
First Line : PO BOX 7066
Second Line :
City : TAMPA
State : FL
Zip : 33673-7066
Country : US
Telephone Number : 813-237-0777
Fax Number : 813-237-2999
Provider Business Practice Location Address
First Line : 5701 N FLORIDA AVE
Second Line :
City : TAMPA
State : FL
Zip : 33604-6913
Country : US
Telephone Number : 813-237-0777
Fax Number : 813-237-2999
Authorized Official
Title or Position : SOLE PROPRIETOR
Name : MOLLY A. MILLER
Credential : PT
Telephone Number : 813-237-0777
Provider Enumeration Date : 08/04/2008
Last Update Date : 08/04/2008

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