Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 40QA00820900 | NJ |
NPI | 1780924324 |
---|---|
Provider Name | Sandra L Miller |
First Address | Ocean, NJ 07712-3316 |
Second Address | Oceanport, NJ 07757-1162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2013 |
Last Update Date | 19/02/2013 |