Basic Information
| Provider Information | |||||||||
| NPI: | 1396218806 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | GABRIELA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5293 FOXRIDGE DR APT 203 | ||||||||
| Address2: | |||||||||
| City: | MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662024525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9139120946 | ||||||||
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| Practice Location | |||||||||
| Address1: | 527 N STATE ROUTE 291 STE A | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640681045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167920849 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2019 | ||||||||
| LastUpdateDate: | 01/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2018028607 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.