Provider Demographics
NPI:1689272734
Name:MILONAS, TRICIA J (LMT)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:J
Last Name:MILONAS
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 1:15027 W BELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3256
Mailing Address - Country:US
Mailing Address - Phone:623-215-4107
Mailing Address - Fax:623-215-7453
Practice Address - Street 1:15027 W BELL RD STE 100
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3256
Practice Address - Country:US
Practice Address - Phone:623-215-4107
Practice Address - Fax:623-215-7453
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-10987225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty