Provider Demographics
NPI:1164918736
Name:MCMILLAN, DIANE ELAINE (LMT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:ELAINE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-2438
Mailing Address - Country:US
Mailing Address - Phone:516-808-4914
Mailing Address - Fax:
Practice Address - Street 1:913 N BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2364
Practice Address - Country:US
Practice Address - Phone:631-355-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-07
Last Update Date:2018-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist