Provider Demographics
NPI:1265687842
Name:MILLER, TRACEY ANTOINETTE (DPT)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:ANTOINETTE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11637 170TH ST
Mailing Address - Street 2:APT. A
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1819
Mailing Address - Country:US
Mailing Address - Phone:718-527-5201
Mailing Address - Fax:
Practice Address - Street 1:11637 170TH ST
Practice Address - Street 2:APT. A
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1819
Practice Address - Country:US
Practice Address - Phone:917-627-7703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist