MEDICARE: JACK LAWRENCE 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	MT-13827	AZ

General Provider Information

NPI Number	:	1407130198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK LAWRENCE MILLER LMT

Provider Business Mailing Address
First Line	:	8936 N ONYX ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-9415
Country	:	US
Telephone Number	:	520-668-6306
Fax Number	:

Provider Business Practice Location Address
First Line	:	7620 N HARTMAN LN STE 184
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-7485
Country	:	US
Telephone Number	:	520-668-6306
Fax Number	:

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

Provider Enumeration Date	:	09/29/2011
Last Update Date	:	09/29/2011

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Directions to “ JACK LAWRENCE MILLER LMT” Practice Location

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