Healthcare Provider Details

I. General information

NPI: 1417314618
Provider Name (Legal Business Name): JOSEPHINA D MILEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6831 N ORACLE RD STE 133
TUCSON AZ
85704-4268
US

IV. Provider business mailing address

7995 E MAGGIE CT
TUCSON AZ
85715-4549
US

V. Phone/Fax

Practice location:
  • Phone: 520-343-1043
  • Fax:
Mailing address:
  • Phone: 520-343-1043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-50054
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: