Provider Demographics
NPI:1396218806
Name:MILLER, MARIA GABRIELA (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GABRIELA
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 1:5293 FOXRIDGE DR APT 203
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-4525
Mailing Address - Country:US
Mailing Address - Phone:913-912-0946
Mailing Address - Fax:
Practice Address - Street 1:527 N STATE ROUTE 291 STE A
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1045
Practice Address - Country:US
Practice Address - Phone:816-792-0849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018028607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist