Healthcare Provider Details

I. General information

NPI: 1457183600
Provider Name (Legal Business Name): AMANDA MILLER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3442 US HIGHWAY 19
HOLIDAY FL
34691-1850
US

IV. Provider business mailing address

24575 NW 160TH AVE
HIGH SPRINGS FL
32643-6887
US

V. Phone/Fax

Practice location:
  • Phone: 727-841-8160
  • Fax: 727-841-8164
Mailing address:
  • Phone: 386-266-9780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217247
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42107
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017561
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6021
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: