Provider Demographics
NPI:1982949921
Name:STILWELL, MIRIAM ANGELA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:ANGELA
Last Name:STILWELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:MIRIAM
Other - Middle Name:ANGELA
Other - Last Name:WIEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1307 BETHPAGE RD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-9034
Mailing Address - Country:US
Mailing Address - Phone:704-938-3866
Mailing Address - Fax:
Practice Address - Street 1:1307 BETHPAGE RD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-9034
Practice Address - Country:US
Practice Address - Phone:704-938-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA3378225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant