Provider Demographics
NPI:1134752215
Name:MILLER, SARAH JO (LMT)
Entity type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:JO
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:APT A202
Mailing Address - City:MANISTIQUE
Mailing Address - State:MI
Mailing Address - Zip Code:49854
Mailing Address - Country:US
Mailing Address - Phone:906-286-9079
Mailing Address - Fax:
Practice Address - Street 1:610 E LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854
Practice Address - Country:US
Practice Address - Phone:906-286-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501011863225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7501011863OtherVA