Healthcare Provider Details

I. General information

NPI: 1316403074
Provider Name (Legal Business Name): DANIEL MILLAR PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10811 SE KENT KANGLEY RD
KENT WA
98030-7108
US

IV. Provider business mailing address

10811 SE KENT KANGLEY RD
KENT WA
98030-7108
US

V. Phone/Fax

Practice location:
  • Phone: 253-854-5660
  • Fax: 253-854-7025
Mailing address:
  • Phone: 253-854-5660
  • Fax: 253-854-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number300182
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT61389435
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1315122
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: