Provider Demographics
NPI:1124849823
Name:MILLER, JORDAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
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 1:151 ACCO DR
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4409
Mailing Address - Country:US
Mailing Address - Phone:315-323-3563
Mailing Address - Fax:
Practice Address - Street 1:7329 SENECA RD N
Practice Address - Street 2:
Practice Address - City:NORTH HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-9684
Practice Address - Country:US
Practice Address - Phone:607-247-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist