MEDICARE: MR. JOSEPH ANTHONY MIGGINS P.T.

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	5905	FL

General Provider Information

NPI Number	:	1790779510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH ANTHONY MIGGINS P.T.

Provider Business Mailing Address
First Line	:	12670 CREEKSIDE LN
Second Line	:	SUITE 202
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3370
Country	:	US
Telephone Number	:	239-482-2663
Fax Number	:

Provider Business Practice Location Address
First Line	:	12670 CREEKSIDE LN
Second Line	:	SUITE 202
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3370
Country	:	US
Telephone Number	:	239-482-2663
Fax Number	:

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	05/03/2011

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