=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457275075
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA MILLER LMT, RYT, CMA, MLD-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2026
-----------------------------------------------------
Last Update Date | 08/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 925 WAPPOO RD STE F
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29407-5969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 854-207-2974
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 323
-----------------------------------------------------
City | GOOSE CREEK
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29445-0323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 854-201-2974
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 13488
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------