Provider Demographics
NPI:1386047041
Name:MILLER, DAVID LEE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
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 1:45 ORIENT AVE BSMT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2502
Mailing Address - Country:US
Mailing Address - Phone:718-569-5513
Mailing Address - Fax:
Practice Address - Street 1:330 W 42ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6902
Practice Address - Country:US
Practice Address - Phone:718-569-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28961225100000X
TX1250455225100000X
UT8601983-2401225100000X
NY040913-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist