Provider Demographics
NPI:1053356600
Name:MIKLOUCICH, FRANK J JR (DPT)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:J
Last Name:MIKLOUCICH
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:MR
Other - First Name:FRANCIS
Other - Middle Name:J
Other - Last Name:MIKLOUCICH
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:3060 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5246
Mailing Address - Country:US
Mailing Address - Phone:910-346-3151
Mailing Address - Fax:910-346-2975
Practice Address - Street 1:3060 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5246
Practice Address - Country:US
Practice Address - Phone:910-346-3151
Practice Address - Fax:910-346-2975
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027719225100000X
NY027719-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB0730Medicare UPIN