Provider Demographics
NPI:1285779876
Name:MILLER, HOLLY JEAN (MPT)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7970 CENTURY OAK DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-8303
Mailing Address - Country:US
Mailing Address - Phone:941-924-4686
Mailing Address - Fax:941-924-4686
Practice Address - Street 1:3982 BEE RIDGE RD STE K
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1210
Practice Address - Country:US
Practice Address - Phone:941-377-6700
Practice Address - Fax:941-377-6700
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT14906OtherLICENSE NUMBER
FL885717200Medicaid