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General NPI Number Information
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NPI Number | 1053023739
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Entity Type | Individual
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Provider Name | MICHAEL MILLER PT, DPT, ATC
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Gender | Male
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 5320 W GENESEE ST
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City | CAMILLUS
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State | NY
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Zip | 13031-2268
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Country | US
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Telephone | 315-469-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 3408 HAMMOCKS DR APT 206
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City | BALDWINSVILLE
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State | NY
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Zip | 13027-4228
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Country | US
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Telephone | 716-697-3665
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 049621-01
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License Number State | NY
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