Active NPI
Tracey Antoinette Miller, DPT
- Physical Therapist
- Jamaica, NY
National Provider Identifier
1265687842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 028669
- Practice address
- 11637 170TH St
Apt. a
Jamaica, NY 11434-1819 - Phone
- (917) 627-7703
- NPI assigned
- Nov 24, 2008
- Last updated
- Nov 24, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 028669 | NY | Primary |
Addresses
Primary practice location
11637 170TH St
Apt. a
Jamaica, NY 11434-1819
Mailing address
11637 170TH St
Apt. a
Jamaica, NY 11434-1819
Phone (718) 527-5201
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 028669 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Functional Lifestyles Physical and Occupational Therapy PLLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Occupational Therapist
- Flushing, NY
- NPI 1790945020
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227484800000",
"number": "1265687842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11637 170TH ST",
"address_2": "APT. A",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114341819",
"telephone_number": "718-527-5201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11637 170TH ST",
"address_2": "APT. A",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114341819",
"telephone_number": "917-627-7703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "TRACEY",
"middle_name": "ANTOINETTE",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-24",
"last_updated": "2008-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "028669",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamaica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.