Healthcare Provider Details

I. General information

NPI: 1770077844
Provider Name (Legal Business Name): MILENA MIJATOVIC PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 S JOG RD STE B8
DELRAY BEACH FL
33446-1246
US

IV. Provider business mailing address

15200 S JOG RD STE B8
DELRAY BEACH FL
33446-1246
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-7171
  • Fax:
Mailing address:
  • Phone: 561-495-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT33680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: