Provider Demographics
NPI:1326729815
Name:MILLER, KAYLEIGH CHRISTINE (LMT)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:CHRISTINE
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 1:391 SE ELOISE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-3507
Mailing Address - Country:US
Mailing Address - Phone:386-623-8680
Mailing Address - Fax:
Practice Address - Street 1:169 NW GWEN LAKE AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3711
Practice Address - Country:US
Practice Address - Phone:386-984-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA95336225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist