Provider Demographics
NPI:1639508211
Name:MILLER, DANIEL I
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MILLER
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-9201
Mailing Address - Country:US
Mailing Address - Phone:810-386-7723
Mailing Address - Fax:989-386-3525
Practice Address - Street 1:600 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-9201
Practice Address - Country:US
Practice Address - Phone:810-386-7723
Practice Address - Fax:989-386-3525
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502000655225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant