Healthcare Provider Details

I. General information

NPI: 1134971849
Provider Name (Legal Business Name): SARAH MILLER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 FORUM BLVD STE 3
COLUMBIA MO
65203-5450
US

IV. Provider business mailing address

1805 MADISON PARK DR
COLUMBIA MO
65203-2596
US

V. Phone/Fax

Practice location:
  • Phone: 573-257-8580
  • Fax:
Mailing address:
  • Phone: 660-247-1043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2019019562
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: