Provider Demographics
NPI:1942028527
Name:MILLER, HEATHER GLYN (LMT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:GLYN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 FOX RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-9465
Mailing Address - Country:US
Mailing Address - Phone:937-654-3668
Mailing Address - Fax:
Practice Address - Street 1:5495 S STATE ROUTE 49
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1031
Practice Address - Country:US
Practice Address - Phone:937-654-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
OH33.027056225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist