Healthcare Provider Details

I. General information

NPI: 1376495416
Provider Name (Legal Business Name): MELISSA E MILLER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISSY MILLER LMT

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5683 TUCKER CIR
PACE FL
32571-1398
US

IV. Provider business mailing address

5683 TUCKER CIR
PACE FL
32571-1398
US

V. Phone/Fax

Practice location:
  • Phone: 850-857-2101
  • Fax:
Mailing address:
  • Phone: 850-857-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA92771
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: