MEDICARE: MS. DEANNA J MILLER PT, MPT, PCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	2006002178	MO

General Provider Information

NPI Number	:	1053536342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEANNA J MILLER PT, MPT, PCS

Provider Business Mailing Address
First Line	:	9068 PRIVATE ROAD 6421
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-6693
Country	:	US
Telephone Number	:	417-543-2744
Fax Number	:	417-256-1584

Provider Business Practice Location Address
First Line	:	9068 PRIVATE ROAD 6421
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-6693
Country	:	US
Telephone Number	:	417-543-2744
Fax Number	:	417-256-1584

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	09/09/2013

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