Provider Demographics
NPI:1982754677
Name:MILLER, LORETTA J (PT)
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LORETTA
Other - Middle Name:J
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4717 HERMITAGE RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-3611
Mailing Address - Country:US
Mailing Address - Phone:716-298-5317
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-3801
Practice Address - Fax:716-897-8081
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014184-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist