Healthcare Provider Details

I. General information

NPI: 1689538696
Provider Name (Legal Business Name): TREY ROSHAUN MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3718 CHURCH RD
MOUNT LAUREL NJ
08054-1104
US

IV. Provider business mailing address

112 RIDGEWOOD WAY
BURLINGTON NJ
08016-4272
US

V. Phone/Fax

Practice location:
  • Phone: 407-443-6155
  • Fax:
Mailing address:
  • Phone: 407-443-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02285300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: