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General NPI Number Information
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NPI Number | 1023135456
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Entity Type | Individual
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Provider Name | AMANDA DELOACH MILLER MPT
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1958 OLD OCILLA RD
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City | TIFTON
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State | GA
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Zip | 31794-1645
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Country | US
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Telephone | 229-386-0421
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Fax |
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Provider Business Mailing Address
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Address Line | 1704 FREDERICA RD APT 231
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City | SAINT SIMONS ISLAND
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State | GA
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Zip | 31522-2552
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Country | US
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Telephone | 229-251-2336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT009005
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License Number State | GA
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