Healthcare Provider Details

I. General information

NPI: 1154543338
Provider Name (Legal Business Name): TODD GIBBONS MILLER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 MCFARLAND BLVD
NORTHPORT AL
35476-3326
US

IV. Provider business mailing address

212 MCFARLAND BLVD
NORTHPORT AL
35476-3326
US

V. Phone/Fax

Practice location:
  • Phone: 205-333-5351
  • Fax: 205-333-5345
Mailing address:
  • Phone: 205-333-5351
  • Fax: 205-333-5345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTH3433
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: