Individual
CARLY MILLESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1103 N THORNTON AVE, ORLANDO, FL 32803-2525
(321) 430-0551
Mailing address
1103 N THORNTON AVE, ORLANDO, FL 32803-2525
(321) 430-0551
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
815138162
FL
Other
Enumeration date
07/23/2019
Last updated
07/23/2019
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