Provider Demographics
NPI:1922278266
Name:MILLER, JOANNA (LMP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 WESTRIDGE AVE W APT E11
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98466-8215
Mailing Address - Country:US
Mailing Address - Phone:253-302-3347
Mailing Address - Fax:
Practice Address - Street 1:124 4TH AVE S STE 250
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5879
Practice Address - Country:US
Practice Address - Phone:253-854-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024577225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist