Provider Demographics
NPI:1073749198
Name:MILLER, TONDA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:TONDA
Middle Name:MARIE
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 1:2461 W SR 426
Mailing Address - Street 2:SUITE 1051
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4508
Mailing Address - Country:US
Mailing Address - Phone:407-718-3645
Mailing Address - Fax:407-971-8183
Practice Address - Street 1:2461 W SR 426
Practice Address - Street 2:SUITE 1051
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4508
Practice Address - Country:US
Practice Address - Phone:407-718-3645
Practice Address - Fax:407-971-8183
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44109225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist