Provider Demographics
NPI:1790981165
Name:DISNEY-FALLER, MIRI ALLYN (MSPT, AT,C)
Entity Type:Individual
Prefix:MRS
First Name:MIRI
Middle Name:ALLYN
Last Name:DISNEY-FALLER
Suffix:
Gender:F
Credentials:MSPT, AT,C
Other - Prefix:MS
Other - First Name:MIRI
Other - Middle Name:ALLYN
Other - Last Name:DISNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4044
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-4044
Mailing Address - Country:US
Mailing Address - Phone:406-926-2440
Mailing Address - Fax:406-926-2441
Practice Address - Street 1:2244 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6502
Practice Address - Country:US
Practice Address - Phone:406-926-2440
Practice Address - Fax:406-926-2441
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1967PT2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic