Provider Demographics
NPI:1215924915
Name:MILEJCZAK, DANIEL ERIC II (MSPT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ERIC
Last Name:MILEJCZAK
Suffix:II
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BROADWAY AVE N
Mailing Address - Street 2:PO BOX 416
Mailing Address - City:FOLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56329-8794
Mailing Address - Country:US
Mailing Address - Phone:320-968-4677
Mailing Address - Fax:
Practice Address - Street 1:400 BROADWAY AVE N
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329-8794
Practice Address - Country:US
Practice Address - Phone:320-968-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN169330OtherUCARE
MN84508OtherHEALTH PARTNERS
MN1031097OtherPREFERRED ONE
MN065M7FOOtherBLUE CROSS BLUE SHIELD
MN135143500Medicaid
MN7312142OtherAETNA