Healthcare Provider Details

I. General information

NPI: 1780775155
Provider Name (Legal Business Name): MATTHEW R MILLER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 BELMAR BLVD COLFAX PLAZA
WALL NJ
07719-3948
US

IV. Provider business mailing address

PO BOX 1703
WALL NJ
07719
US

V. Phone/Fax

Practice location:
  • Phone: 732-681-1122
  • Fax: 732-681-0999
Mailing address:
  • Phone: 732-681-1122
  • Fax: 732-681-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00464800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: