Provider Demographics
NPI:1275964702
Name:USMILLER, SAMANTHA PAINTER (LMT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:PAINTER
Last Name:USMILLER
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 1:721 S GRANITE ST APT A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4289
Mailing Address - Country:US
Mailing Address - Phone:815-322-3450
Mailing Address - Fax:
Practice Address - Street 1:721 S GRANITE ST APT A
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4289
Practice Address - Country:US
Practice Address - Phone:815-322-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-17713225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist