Healthcare Provider Details

I. General information

NPI: 1346388121
Provider Name (Legal Business Name): MARTHA T MIOUX PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W CEDAR AVE
EFFINGHAM IL
62401-2917
US

IV. Provider business mailing address

202 W CEDAR AVE
EFFINGHAM IL
62401-2917
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-4107
  • Fax: 217-342-4107
Mailing address:
  • Phone: 217-342-4107
  • Fax: 217-342-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: