Provider Demographics
NPI:1831953298
Name:MILLO, LAURIE (LMT)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:MILLO
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 1:260 VILLAGE BLVD APT 5206
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2496
Mailing Address - Country:US
Mailing Address - Phone:203-258-0780
Mailing Address - Fax:
Practice Address - Street 1:725 N HIGHWAY A1A STE E108
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-9514
Practice Address - Country:US
Practice Address - Phone:561-730-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA75583225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist