Provider Demographics
NPI:1205114923
Name:MILLER, SAMINTHA L (LMT)
Entity type:Individual
Prefix:MS
First Name:SAMINTHA
Middle Name:L
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 1:10 JACOBS ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4310
Mailing Address - Country:US
Mailing Address - Phone:781-526-5049
Mailing Address - Fax:
Practice Address - Street 1:10 JACOBS ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4310
Practice Address - Country:US
Practice Address - Phone:781-526-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3747174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist