Provider Demographics
NPI:1477330363
Name:MILLER, JONATHON M (LMT)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:M
Last Name:MILLER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 COLUMBUS WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-1848
Mailing Address - Country:US
Mailing Address - Phone:775-813-6773
Mailing Address - Fax:
Practice Address - Street 1:5301 LONGLEY LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1805
Practice Address - Country:US
Practice Address - Phone:775-813-6773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.9864225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist