Provider Demographics
NPI:1003014978
Name:MILLER, MELISSA JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W GIACONDA WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4341
Mailing Address - Country:US
Mailing Address - Phone:520-858-0350
Mailing Address - Fax:520-448-0819
Practice Address - Street 1:231 W GIACONDA WAY STE 103
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4341
Practice Address - Country:US
Practice Address - Phone:520-858-0350
Practice Address - Fax:520-448-0819
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019851225700000X
AZM23522225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist