Provider Demographics
NPI:1871831925
Name:REED, MIRANDA J (CPTA)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:J
Last Name:REED
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W WILLOW GLN
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:KS
Mailing Address - Zip Code:67063-1932
Mailing Address - Country:US
Mailing Address - Phone:620-947-0107
Mailing Address - Fax:
Practice Address - Street 1:619 S CLARK AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-3003
Practice Address - Country:US
Practice Address - Phone:620-257-7118
Practice Address - Fax:620-257-7189
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01202225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant