Healthcare Provider Details

I. General information

NPI: 1770533705
Provider Name (Legal Business Name): PATRICK MILLER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/14/2021
Certification Date: 08/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 SHAWNEE MISSION PKWY # C15
OVERLAND PARK KS
66202-4401
US

IV. Provider business mailing address

7520 SHAWNEE MISSION PKWY # C15
OVERLAND PARK KS
66202-4401
US

V. Phone/Fax

Practice location:
  • Phone: 816-842-9589
  • Fax:
Mailing address:
  • Phone: 816-842-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4005
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2003030459
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: