Provider Demographics
NPI:1831995570
Name:MILLER, LEE NATHANIEL JR
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:NATHANIEL
Last Name:MILLER
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 BLAKESHIRE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-9711
Mailing Address - Country:US
Mailing Address - Phone:336-615-0275
Mailing Address - Fax:
Practice Address - Street 1:301 STATE ST STE F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-5939
Practice Address - Country:US
Practice Address - Phone:336-312-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22102225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist