Healthcare Provider Details

I. General information

NPI: 1407638596
Provider Name (Legal Business Name): MYISHA STRATTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYISHA MILLER

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 N YORK RD
WILLOW GROVE PA
19090-3415
US

IV. Provider business mailing address

402 W TABOR RD
PHILADELPHIA PA
19120-2810
US

V. Phone/Fax

Practice location:
  • Phone: 267-453-9855
  • Fax: 215-346-2555
Mailing address:
  • Phone: 267-453-9855
  • Fax: 215-346-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCO222708L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: