Provider Demographics
NPI:1326143702
Name:MILLER, TERESA MARIE (PHYSICAL THEREPIST)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHYSICAL THEREPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2232
Mailing Address - Country:US
Mailing Address - Phone:785-742-7606
Mailing Address - Fax:785-742-4490
Practice Address - Street 1:700 OREGON ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2232
Practice Address - Country:US
Practice Address - Phone:785-742-7606
Practice Address - Fax:785-742-4490
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1102723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS141023Medicare ID - Type Unspecified