Provider Demographics
NPI:1609898949
Name:MILLER, DIANE WINNER
Entity type:Individual
Prefix:PROF
First Name:DIANE
Middle Name:WINNER
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 EARLIE COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:CASTALIA
Mailing Address - State:NC
Mailing Address - Zip Code:27816-9111
Mailing Address - Country:US
Mailing Address - Phone:919-853-2511
Mailing Address - Fax:
Practice Address - Street 1:1501 N BICKETT BLVD STE E
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2178
Practice Address - Country:US
Practice Address - Phone:919-497-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2409225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant