Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 40QA01310100 | NJ |
Y | 2251X0800X | Physical Therapist - Orthopedic | 40QA01310100 | NJ |
NPI | 1205126752 |
---|---|
Provider Name | Mrs. Miriam Dana Hillman |
First Address | Millburn, NJ 07041-1847 |
Second Address | Millburn, NJ 07041-1847 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2011 |
Last Update Date | 17/04/2011 |