Provider Demographics
NPI:1699500678
Name:MILLER, STEVEN WALTER (PTA)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:WALTER
Last Name:MILLER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 COLUMBUS PL
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1051
Mailing Address - Country:US
Mailing Address - Phone:732-735-6412
Mailing Address - Fax:
Practice Address - Street 1:259 PATERSON AVE UNIT 4
Practice Address - Street 2:
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057-1918
Practice Address - Country:US
Practice Address - Phone:201-340-4656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00311800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant