Healthcare Provider Details

I. General information

NPI: 1568670644
Provider Name (Legal Business Name): JOAN MILLER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 S FLORIDA AVE ABBEY BUSINESS PARK, STE 321-B
LAKELAND FL
33803-4053
US

IV. Provider business mailing address

PO BOX 7504
LAKELAND FL
33807-7504
US

V. Phone/Fax

Practice location:
  • Phone: 863-644-7330
  • Fax:
Mailing address:
  • Phone: 863-644-7330
  • Fax: 863-619-8764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPTFL4075
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTFL4075
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: