Healthcare Provider Details

I. General information

NPI: 1154888444
Provider Name (Legal Business Name): EMILY MILLER ATS, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 4TH AVE
STEVENS POINT WI
54481-1910
US

IV. Provider business mailing address

1901 TEXAS AVE APT 209
STEVENS POINT WI
54481-4267
US

V. Phone/Fax

Practice location:
  • Phone: 920-723-4644
  • Fax:
Mailing address:
  • Phone: 920-723-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13906-146
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: