Healthcare Provider Details

I. General information

NPI: 1871359653
Provider Name (Legal Business Name): ROD A MILLER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 SW 20TH PL STE 102
OCALA FL
34471-0869
US

IV. Provider business mailing address

13020 N TELECOM PARKWAY
TEMPLE TERRRACE FL
33637-0925
US

V. Phone/Fax

Practice location:
  • Phone: 352-647-9700
  • Fax: 352-525-4994
Mailing address:
  • Phone: 813-978-9700
  • Fax: 813-558-6185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA16646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: