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General NPI Number Information
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NPI Number | 1932918430
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Entity Type | Individual
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Provider Name | LORRAINE CLAIRE MILLER MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 2130 2ND ST
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-3207
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Country | US
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Telephone | 651-762-8040
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Fax |
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Provider Business Mailing Address
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Address Line | 2206 VINING DR UNIT H
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City | WOODBURY
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State | MN
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Zip | 55125-7573
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Country | US
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Telephone | 469-307-3100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 00010462
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License Number State | MN
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