Provider Demographics
NPI:1124299151
Name:STUART, KATARINA MILJKOVIC (LMT)
Entity type:Individual
Prefix:
First Name:KATARINA
Middle Name:MILJKOVIC
Last Name:STUART
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 1:215 SE 6TH ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2404
Mailing Address - Country:US
Mailing Address - Phone:541-326-2241
Mailing Address - Fax:
Practice Address - Street 1:215 SE 6TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2404
Practice Address - Country:US
Practice Address - Phone:541-326-2241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3503172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist