MEDICARE: CARLA B MILLER

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	10321	NC

General Provider Information

NPI Number	:	1568968766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA B MILLER

Provider Business Mailing Address
First Line	:	PO BOX 984
Second Line	:
City	:	FRANKLINTON
State	:	NC
Zip	:	27525-0984
Country	:	US
Telephone Number	:	919-414-9232
Fax Number	:

Provider Business Practice Location Address
First Line	:	2232 PAGE RD STE 201
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-7724
Country	:	US
Telephone Number	:	919-414-9232
Fax Number	:

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

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	04/05/2018

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