Jacob Miller, PT, DPT
Individual provider Active NPI Physical Therapist · Tampa, FL
NPI 1376158592 · NPPES record last updated Sep 14, 2020
Key facts
- NPI
- 1376158592
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT36351 (FL)
- Practice address
- 3633 W Waters Ave Ste 700
Tampa, FL 33614-2783 - Phone
- (813) 932-5119
- NPI assigned
- Sep 14, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT36351 | FL | MD | Physical Therapist |
Practice roles (2 of 4)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cora Health Services, Inc | Past |
Accepting new patients | |
| Cora Health Services Inc | Past |
Accepting new patients |
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT36351 | FL | Yes |
Addresses
Primary practice location
3633 W Waters Ave Ste 700
Tampa, FL 33614-2783
Mailing address
712 S Howard Ave Apt 459
Tampa, FL 33606-2490
Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.