Provider Demographics
NPI:1932719119
Name:MILLER, SYDNEY JOANN (PT DPT)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:JOANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LIGHTHOUSE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-1423
Mailing Address - Country:US
Mailing Address - Phone:831-375-5909
Mailing Address - Fax:831-375-7259
Practice Address - Street 1:500 LIGHTHOUSE AVE STE B
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1423
Practice Address - Country:US
Practice Address - Phone:831-375-5909
Practice Address - Fax:831-375-7259
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist