MEDICARE: BETH JORDAN MILLER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	25181	OR

General Provider Information

NPI Number	:	1215700513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH JORDAN MILLER LMT

Provider Business Mailing Address
First Line	:	60943 SE SWEET PEA DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-9759
Country	:	US
Telephone Number	:	541-610-5497
Fax Number	:

Provider Business Practice Location Address
First Line	:	628 NW YORK DR STE 205
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-1572
Country	:	US
Telephone Number	:	541-728-3911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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