Provider Demographics
NPI:1285640854
Name:MILLER, KIM (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HILLTOP VILLAGE CENTER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1108
Mailing Address - Country:US
Mailing Address - Phone:636-938-9373
Mailing Address - Fax:636-938-9373
Practice Address - Street 1:113 HILLTOP VILLAGE CENTER DR
Practice Address - Street 2:SUITE B
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1108
Practice Address - Country:US
Practice Address - Phone:636-938-9373
Practice Address - Fax:636-938-9373
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6400127OtherMEDICARE COMPLETE
MO6400127OtherUNITED HEALTH CARE
MO320062OtherHEALTH PARTNERS
MO127499OtherBLUE CROSS BLUE SHIELD
MO124158OtherHEALTHLINK