Provider Demographics
NPI:1467966168
Name:MILLER PLACE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MILLER PLACE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCREA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:631-331-2348
Mailing Address - Street 1:41 ECHO AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2108
Mailing Address - Country:US
Mailing Address - Phone:631-553-8370
Mailing Address - Fax:631-928-7068
Practice Address - Street 1:41 ECHO AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2108
Practice Address - Country:US
Practice Address - Phone:631-331-2348
Practice Address - Fax:631-928-7068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011801261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy