Healthcare Provider Details

I. General information

NPI: 1548683766
Provider Name (Legal Business Name): ALISA MAY MILLER LCMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 BROADWAY AVE
YANKTON SD
57078-4240
US

IV. Provider business mailing address

231 BROADWAY AVE
YANKTON SD
57078-4240
US

V. Phone/Fax

Practice location:
  • Phone: 605-689-4000
  • Fax:
Mailing address:
  • Phone: 605-689-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1187
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: