Provider Demographics
NPI:1679263420
Name:MILLER, AMANDA M (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
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 1:1219 HARD ROCK RD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:MT
Mailing Address - Zip Code:59828-9327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1219 HARD ROCK RD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:MT
Practice Address - Zip Code:59828-9327
Practice Address - Country:US
Practice Address - Phone:406-451-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist