Provider Demographics
NPI:1154709590
Name:MILLER, DANIELLE (DPT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1 CREDIT UNION WAY FL 3
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4633
Mailing Address - Country:US
Mailing Address - Phone:133-923-7350
Mailing Address - Fax:781-961-1291
Practice Address - Street 1:75 FINNELL DR
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-1110
Practice Address - Country:US
Practice Address - Phone:781-335-1151
Practice Address - Fax:781-335-7851
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110119892AMedicaid