Provider Demographics
NPI:1396855748
Name:MILLER, LORI K (PT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:K
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 1:12114 S 71 HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030
Mailing Address - Country:US
Mailing Address - Phone:816-877-0561
Mailing Address - Fax:816-877-0565
Practice Address - Street 1:12114 S 71 HIGHWAY
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030
Practice Address - Country:US
Practice Address - Phone:816-877-0561
Practice Address - Fax:816-877-0565
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1103753225100000X
MO20070304882251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO39796012OtherBLUE CROSS BLUE SHIELD
TX8T3264OtherBLUE CROSS BLUE SHIELD