Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2006002178 | MO |
NPI | 1053536342 |
---|---|
Provider Name | Ms. Deanna J Miller |
First Address | West Plains, MO 65775-6693 |
Second Address | West Plains, MO 65775-6693 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 09/09/2013 |