Provider Demographics
NPI:1649876178
Name:MILLNER, BREONA L (DPT)
Entity type:Individual
Prefix:DR
First Name:BREONA
Middle Name:L
Last Name:MILLNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 FETTLER PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-2049
Mailing Address - Country:US
Mailing Address - Phone:571-427-4378
Mailing Address - Fax:571-833-4378
Practice Address - Street 1:124 OLD POTOMAC CHURCH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7257
Practice Address - Country:US
Practice Address - Phone:571-427-4378
Practice Address - Fax:571-833-4378
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214767225100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program