Provider Demographics
NPI:1265647499
Name:MILLER, ALBERTA LERAE (PT)
Entity type:Individual
Prefix:MS
First Name:ALBERTA
Middle Name:LERAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ALBERTA
Other - Middle Name:LERAE
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3731 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-1468
Mailing Address - Country:US
Mailing Address - Phone:417-439-7878
Mailing Address - Fax:
Practice Address - Street 1:3731 VALLEY DR
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-1468
Practice Address - Country:US
Practice Address - Phone:417-439-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist