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General NPI Number Information
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NPI Number | 1295784668
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Entity Type | Organization
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Legal Business Name | CRESTVIEW PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 577 BROOKMEADE DR
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City | CRESTVIEW
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State | FL
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Zip | 32539-6029
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Country | US
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Telephone | 850-682-7466
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Fax | 850-682-6591
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Provider Business Mailing Address
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Address Line | PO BOX 2010
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City | CRESTVIEW
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State | FL
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Zip | 32536-8010
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Country | US
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Telephone | 850-682-7466
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Fax | 850-682-6591
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS A. MILLER
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Credential | P.T.
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Telephone | 850-682-7466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA18906
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT0002988
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT2988
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License Number State | FL
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