Healthcare Provider Details

I. General information

NPI: 1164504114
Provider Name (Legal Business Name): DAVID R MILROY MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 EDWARDS MILL RD STE 200
RALEIGH NC
27612-5243
US

IV. Provider business mailing address

3001 EDWARDS MILL RD STE 200
RALEIGH NC
27612-5243
US

V. Phone/Fax

Practice location:
  • Phone: 919-863-6856
  • Fax:
Mailing address:
  • Phone: 919-781-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberP22872
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP22872
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: