Healthcare Provider Details

I. General information

NPI: 1619583770
Provider Name (Legal Business Name): CHRISTY MILLER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463155 STATE ROAD 200 UNIT 121314
YULEE FL
32097-5506
US

IV. Provider business mailing address

75259 PLUMBAGO TRCE
YULEE FL
32097-0156
US

V. Phone/Fax

Practice location:
  • Phone: 904-849-1625
  • Fax: 904-775-4478
Mailing address:
  • Phone: 904-849-1625
  • Fax: 904-775-4478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY PETRAS MILLER
Title or Position: OWNER
Credential: OTR/L
Phone: 706-834-6139