Provider Demographics
NPI:1215020284
Name:MILLER, DONNA (PT)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 VETERANS HWY
Mailing Address - Street 2:SUITE 13
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-1074
Mailing Address - Country:US
Mailing Address - Phone:631-630-6485
Mailing Address - Fax:631-630-6486
Practice Address - Street 1:3920 VETERANS HWY
Practice Address - Street 2:SUITE 13
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1074
Practice Address - Country:US
Practice Address - Phone:631-630-6485
Practice Address - Fax:631-630-6486
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024623174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist