MEDICARE: MIA D EARL PH.D., MPH, CHES

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	173C00000X	Reflexologist	RCR0000000163	TN

General Provider Information

NPI Number	:	1891927356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA D EARL PH.D., MPH, CHES

Provider Business Mailing Address
First Line	:	5731 NANJACK CIR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-2058
Country	:	US
Telephone Number	:	901-240-0980
Fax Number	:

Provider Business Practice Location Address
First Line	:	5731 NANJACK CIR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-2058
Country	:	US
Telephone Number	:	901-240-0980
Fax Number	:

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

Provider Enumeration Date	:	08/18/2009
Last Update Date	:	06/15/2019

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