Provider Demographics
NPI:1861705592
Name:MILSON, SUMMER DAWN (LMP)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:DAWN
Last Name:MILSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 E TOP AVE
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-9665
Mailing Address - Country:US
Mailing Address - Phone:509-290-0591
Mailing Address - Fax:
Practice Address - Street 1:524 S UNIVERSITY RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5557
Practice Address - Country:US
Practice Address - Phone:509-290-0591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60161787225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist