Provider Demographics
NPI:1164574075
Name:MILLER, SUSAN DOROTHY (PT, DPT, MS, OCS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DOROTHY
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT, DPT, MS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4468 STATE ROUTE 281
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-8893
Mailing Address - Country:US
Mailing Address - Phone:607-756-7375
Mailing Address - Fax:
Practice Address - Street 1:FADDEN & ASSOCIATES PHYSICAL THERAPY, PLLC
Practice Address - Street 2:242 PORT WATSON STREET
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045
Practice Address - Country:US
Practice Address - Phone:607-758-7212
Practice Address - Fax:607-758-3416
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003252-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5507146OtherAETNA US HEALTHCARE
NY4123844OtherMVP
NY4123844OtherMVP