Provider Demographics
NPI:1255874756
Name:MILLER, JAMES G III (LAT, ATC, PES)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:MILLER
Suffix:III
Gender:M
Credentials:LAT, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16416 130TH WAY N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-6501
Mailing Address - Country:US
Mailing Address - Phone:561-758-8069
Mailing Address - Fax:
Practice Address - Street 1:16416 130TH WAY N
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33478-6501
Practice Address - Country:US
Practice Address - Phone:561-758-8069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL14632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer