Provider Demographics
NPI:1982745717
Name:MILLER, EILEEN B (PT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:B
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BOWERS DR
Mailing Address - Street 2:
Mailing Address - City:HURLEYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12747-5029
Mailing Address - Country:US
Mailing Address - Phone:845-436-6127
Mailing Address - Fax:
Practice Address - Street 1:162 E BROADWAY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-8815
Practice Address - Country:US
Practice Address - Phone:845-796-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYO11822-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist