Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 2251P0200X | Physical Therapist - Pediatrics | TX |
NPI | 1003385105 |
---|---|
Provider Name | Cindy Ann Miller |
First Address | Saint Charles, MO 63304-7280 |
Second Address | Houston, TX 77030-2358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2018 |
Last Update Date | 19/11/2018 |