Healthcare Provider Details

I. General information

NPI: 1457275075
Provider Name (Legal Business Name): ANDREA MILLER LMT, RYT, CMA, MLD-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 WAPPOO RD STE F
CHARLESTON SC
29407-5969
US

IV. Provider business mailing address

PO BOX 323
GOOSE CREEK SC
29445-0323
US

V. Phone/Fax

Practice location:
  • Phone: 854-207-2974
  • Fax:
Mailing address:
  • Phone: 854-201-2974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13488
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: