Healthcare Provider Details

I. General information

NPI: 1023641206
Provider Name (Legal Business Name): MALIK D'MAR MILLER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 HUFFMAN MILL RD
BURLINGTON NC
27215-8862
US

IV. Provider business mailing address

120 WILLIAM PENN PLZ
DURHAM NC
27704-2150
US

V. Phone/Fax

Practice location:
  • Phone: 336-584-5544
  • Fax: 336-584-4438
Mailing address:
  • Phone: 919-220-5255
  • Fax: 919-313-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP19325
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: