Provider Demographics
NPI:1336650126
Name:HILLS, MIRANDA DAWN (LMT)
Entity Type:Individual
Prefix:MISS
First Name:MIRANDA
Middle Name:DAWN
Last Name:HILLS
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 1:5167 RIVER RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5349
Mailing Address - Country:US
Mailing Address - Phone:503-967-7874
Mailing Address - Fax:503-967-7871
Practice Address - Street 1:5167 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5349
Practice Address - Country:US
Practice Address - Phone:503-967-7874
Practice Address - Fax:503-967-7871
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16512225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist