Healthcare Provider Details

I. General information

NPI: 1982546453
Provider Name (Legal Business Name): MILES HOLLINGER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 2ND ST STE 45-3
SANTA FE NM
87505-3499
US

IV. Provider business mailing address

1205 MACLOVIA ST UNIT B
SANTA FE NM
87505-3240
US

V. Phone/Fax

Practice location:
  • Phone: 505-919-9616
  • Fax:
Mailing address:
  • Phone: 505-919-9616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2025-0240
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: