Provider Demographics
NPI:1992904429
Name:DEANE, MIA N (LMT)
Entity type:Individual
Prefix:MRS
First Name:MIA
Middle Name:N
Last Name:DEANE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:MIA
Other - Middle Name:N
Other - Last Name:HULIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2408 BELL CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-1752
Mailing Address - Country:US
Mailing Address - Phone:541-261-6170
Mailing Address - Fax:
Practice Address - Street 1:1150 CRATER LAKE AVE
Practice Address - Street 2:STE. G
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6213
Practice Address - Country:US
Practice Address - Phone:541-857-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-14
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13269225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist