Provider Demographics
NPI:1871249334
Name:MILLER, STEPHANIE RENEE (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENEE
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 1:5564 LITTLE DEBBIE PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:COLLEGE DALE
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4356
Mailing Address - Country:US
Mailing Address - Phone:423-498-3400
Mailing Address - Fax:423-498-3401
Practice Address - Street 1:5564 LITTLE DEBBIE PKWY STE 108
Practice Address - Street 2:
Practice Address - City:COLLEGE DALE
Practice Address - State:TN
Practice Address - Zip Code:37363-4356
Practice Address - Country:US
Practice Address - Phone:423-498-3400
Practice Address - Fax:423-498-3401
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000010145225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist