Provider Demographics
NPI:1528210390
Name:PROACTIVE CARE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:PROACTIVE CARE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, OCS, CSCS
Authorized Official - Phone:631-630-6485
Mailing Address - Street 1:3920 VETERANS MEMORIAL HWY STE 13
Mailing Address - Street 2:
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:
Practice Address - Street 1:3920 VETERANS MEMORIAL HWY STE 13
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024623261QP2000X
NY022801261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy