Individual
CARLY MILLEVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
777 MARYVALE DR, BUFFALO, NY 14225-2712
(716) 870-8325
Mailing address
1582 NESBITT DR, NIAGARA FALLS, NY 14304-1039
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
053064-01
NY
Other
Enumeration date
08/26/2024
Last updated
08/26/2024
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