MEDICARE: DANIELLE MILLER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT60797111	WA

General Provider Information

NPI Number	:	1073011532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE MILLER DPT

Provider Business Mailing Address
First Line	:	4220 132ND ST SE STE 101
Second Line	:
City	:	MILL CREEK
State	:	WA
Zip	:	98012-8999
Country	:	US
Telephone Number	:	425-316-8046
Fax Number	:

Provider Business Practice Location Address
First Line	:	22620 SE 4TH ST STE 240
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-7375
Country	:	US
Telephone Number	:	425-200-0054
Fax Number	:	425-636-3272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2018
Last Update Date	:	10/31/2019

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