Healthcare Provider Details

I. General information

NPI: 1316771819
Provider Name (Legal Business Name): DAVID SCOTT MILLER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 921028
DUTCH HARBOR AK
99692-1028
US

IV. Provider business mailing address

PO BOX 921028
DUTCH HARBOR AK
99692-1028
US

V. Phone/Fax

Practice location:
  • Phone: 801-377-1443
  • Fax:
Mailing address:
  • Phone: 801-377-1443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number202838
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: