Provider Demographics
NPI:1619249745
Name:MILIOUKOVA, MARINA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:MILIOUKOVA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300A PRINCETON-HIGHSTOWN ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-1411
Mailing Address - Country:US
Mailing Address - Phone:609-426-4442
Mailing Address - Fax:609-443-0910
Practice Address - Street 1:300A PRINCETON-HIGHSTOWN ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-1411
Practice Address - Country:US
Practice Address - Phone:609-426-4442
Practice Address - Fax:609-443-0910
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00277000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant