Provider Demographics
NPI:1346422763
Name:RITCHIE, MIRANDA DANIELLE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:MIRANDA
Middle Name:DANIELLE
Last Name:RITCHIE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 FURLONG DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-4853
Mailing Address - Country:US
Mailing Address - Phone:573-421-2422
Mailing Address - Fax:
Practice Address - Street 1:1509 FURLONG DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-4853
Practice Address - Country:US
Practice Address - Phone:573-421-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035379225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant