MEDICARE: DR. MATTHEW MILLER PT,DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT37981	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT37981	OTHER	FL	STATE OF FLORIDA DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1619689858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW MILLER PT,DPT

Provider Business Mailing Address
First Line	:	471 SE VALLARTA DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34984-8402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	471 SE VALLARTA DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34984-8402
Country	:	US
Telephone Number	:	585-797-3238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2022
Last Update Date	:	12/19/2022

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