Provider Demographics
NPI:1679098529
Name:MILLARE, JANICE C (RPT)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:C
Last Name:MILLARE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6847 BROADWATER LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-8602
Mailing Address - Country:US
Mailing Address - Phone:561-303-4938
Mailing Address - Fax:
Practice Address - Street 1:SELECT REHABILITATION, LLC
Practice Address - Street 2:2600 COMPASS RD
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026
Practice Address - Country:US
Practice Address - Phone:877-787-3430
Practice Address - Fax:847-386-5190
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP0048225100000X
FLPT36519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MP0048OtherCNMI LICENSING BOARD
FL36519OtherFLORIDA BOARD OF PHYSICAL THERAPY
NM4814OtherNEW MEXICO PHYSICAL THERAPY BOARD