Provider Demographics
NPI:1083734636
Name:MILLER, DANIEL P (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8619S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-2919
Mailing Address - Country:US
Mailing Address - Phone:414-856-1888
Mailing Address - Fax:414-727-5779
Practice Address - Street 1:8619 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-2919
Practice Address - Country:US
Practice Address - Phone:414-856-1888
Practice Address - Fax:414-727-5779
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5703-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40292300Medicaid
WIK100249753Medicare PIN
WI40292300Medicaid