Basic Information
| Provider Information | |||||||||
| NPI: | 1710619762 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MELISSA MILLER MEDICAL MASSAGE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 W GIACONDA WAY STE 103 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857044341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208580350 | ||||||||
| FaxNumber: | 5204480819 | ||||||||
| Practice Location | |||||||||
| Address1: | 231 W GIACONDA WAY STE 103 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857044341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208580350 | ||||||||
| FaxNumber: | 5204480819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2022 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/LMT | ||||||||
| AuthorizedOfficialTelephone: | 5208580350 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | LMT | ||||||||
| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.