Healthcare Provider Details

I. General information

NPI: 1487621140
Provider Name (Legal Business Name): DANNY JAMES MCMILLIAN PT, DSC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDDAC CMR 437
APO AE
09267
US

IV. Provider business mailing address

MEDDAC CMR 437
APO AE
09267
US

V. Phone/Fax

Practice location:
  • Phone: 496217304126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberPT2359
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: