Provider Demographics
NPI:1588742787
Name:MILLROOD, DANIEL (EDM, PT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MILLROOD
Suffix:
Gender:M
Credentials:EDM, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 ROUTE 209
Mailing Address - Street 2:PO BOX 685
Mailing Address - City:KERHONKSON
Mailing Address - State:NY
Mailing Address - Zip Code:12446
Mailing Address - Country:US
Mailing Address - Phone:845-647-4171
Mailing Address - Fax:845-647-4174
Practice Address - Street 1:101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-1310
Practice Address - Country:US
Practice Address - Phone:845-647-4171
Practice Address - Fax:845-647-4174
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161713166174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist