MEDICARE: MS. ELIZABETH ANNE MILETICH 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	CP049395T	NC
2	225100000X	Physical Therapist	2305210400	VA
3	225100000X	Physical Therapist	CP052287T	GA

General Provider Information

NPI Number	:	1932872694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH ANNE MILETICH DPT

Provider Business Mailing Address
First Line	:	5916 BLACKHORSE LN
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-4602
Country	:	US
Telephone Number	:	828-582-6829
Fax Number	:

Provider Business Practice Location Address
First Line	:	5916 BLACKHORSE LN
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-4602
Country	:	US
Telephone Number	:	828-582-6829
Fax Number	:

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

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	04/05/2026

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