Individual
KEN MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
208 NINTH ST, PRIEST RIVER, ID 83856
(208) 448-2808
Mailing address
37012 N BLANCHARD CREEK RD, NEWPORT, WA 99156-9410
(509) 447-5901
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00000022535
WA
Other
Enumeration date
05/08/2007
Last updated
07/08/2007
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