MEDICARE: STEPHANIE RENEE 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	0000010145	TN

General Provider Information

NPI Number	:	1871249334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE RENEE MILLER LMT

Provider Business Mailing Address
First Line	:	5564 LITTLE DEBBIE PKWY STE 108
Second Line	:
City	:	COLLEGE DALE
State	:	TN
Zip	:	37363-4356
Country	:	US
Telephone Number	:	423-498-3400
Fax Number	:	423-498-3401

Provider Business Practice Location Address
First Line	:	5564 LITTLE DEBBIE PKWY STE 108
Second Line	:
City	:	COLLEGE DALE
State	:	TN
Zip	:	37363-4356
Country	:	US
Telephone Number	:	423-498-3400
Fax Number	:	423-498-3401

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

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	03/22/2022

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