Healthcare Provider Details

I. General information

NPI: 1942330964
Provider Name (Legal Business Name): PHILLIP SCOTT MILAM PT ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W GORE ST 300
ORLANDO FL
32806-1044
US

IV. Provider business mailing address

685 LAKE HARBOR CIR
ORLANDO FL
32809-3462
US

V. Phone/Fax

Practice location:
  • Phone: 407-254-2558
  • Fax:
Mailing address:
  • Phone: 407-240-2498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT14949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: