Provider Demographics
NPI:1396058681
Name:MILLER, LORI SOULE (MSPT, ATC/L, CSCS)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:SOULE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSPT, ATC/L, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 SUNSET LAKE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-7556
Mailing Address - Country:US
Mailing Address - Phone:941-497-1737
Mailing Address - Fax:941-497-7889
Practice Address - Street 1:836 SUNSET LAKE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7556
Practice Address - Country:US
Practice Address - Phone:941-497-1737
Practice Address - Fax:941-497-7889
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL1597174400000X
FLPT23378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist