Basic Information
| Provider Information | |||||||||
| NPI: | 1609898949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | WINNER | ||||||||
| NamePrefix: | PROF. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 236 EARLIE COLLINS RD | ||||||||
| Address2: | |||||||||
| City: | CASTALIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278169111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198532511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1501 N BICKETT BLVD STE E | ||||||||
| Address2: | |||||||||
| City: | LOUISBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275492178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194978414 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2409 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.