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General NPI Number Information
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NPI Number | 1689538696
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Entity Type | Individual
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Provider Name | TREY ROSHAUN MILLER
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Gender | Male
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Dates
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Enumeration Date | 12/13/2025
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Last Update Date | 12/13/2025
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Provider Practice Location Address
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Address Line | 3718 CHURCH RD
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-1104
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Country | US
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Telephone | 407-443-6155
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Fax |
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Provider Business Mailing Address
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Address Line | 112 RIDGEWOOD WAY
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City | BURLINGTON
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State | NJ
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Zip | 08016-4272
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Country | US
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Telephone | 407-443-6155
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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 | 40QA02285300
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License Number State | NJ
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