Healthcare Provider Details

I. General information

NPI: 1225942857
Provider Name (Legal Business Name): JONATHAN MILLER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 N EL CAMINO REAL
ENCINITAS CA
92024-1320
US

IV. Provider business mailing address

6221 METROPOLITAN ST STE 101
CARLSBAD CA
92009-3096
US

V. Phone/Fax

Practice location:
  • Phone: 760-632-6942
  • Fax:
Mailing address:
  • Phone: 760-632-6942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: