Provider Demographics
NPI:1639324379
Name:MILLER, CRYSTAL (PT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:GARRITANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:90 NORTHERN BLVD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1213
Mailing Address - Country:US
Mailing Address - Phone:516-626-5080
Mailing Address - Fax:516-626-5081
Practice Address - Street 1:90 NORTHERN BLVD UNIT 6
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1213
Practice Address - Country:US
Practice Address - Phone:516-626-5080
Practice Address - Fax:516-626-5081
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist