1285145227 NPI number — TONYA LATREASE MILLER BA, CDPT

Table of content: TONYA LATREASE MILLER BA, CDPT (NPI 1285145227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285145227 NPI number — TONYA LATREASE MILLER BA, CDPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
TONYA
Provider Middle Name:
LATREASE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA, CDPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
TONYA
Provider Other Middle Name:
LATREASE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BA, CDPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285145227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24823 PACIFIC HWY S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98032-5478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-681-0010
Provider Business Mailing Address Fax Number:
253-680-0014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24823 PACIFIC HWY S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-5478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-681-0010
Provider Business Practice Location Address Fax Number:
253-681-0014
Provider Enumeration Date:
10/17/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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