Provider Demographics
NPI:1013315175
Name:MILLER, LAURIE (LMT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
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 1:25564 HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-9646
Mailing Address - Country:US
Mailing Address - Phone:541-729-7038
Mailing Address - Fax:
Practice Address - Street 1:25275 LOTEN WAY
Practice Address - Street 2:
Practice Address - City:VENETA
Practice Address - State:OR
Practice Address - Zip Code:97487-9425
Practice Address - Country:US
Practice Address - Phone:541-554-4231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20364172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist