Healthcare Provider Details

I. General information

NPI: 1124884879
Provider Name (Legal Business Name): MISS MIA GREER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4871 SOCASTEE BLVD UNIT E
MYRTLE BEACH SC
29588-7252
US

IV. Provider business mailing address

3895 W EDGEWATER DR
FAYETTEVILLE AR
72704-6347
US

V. Phone/Fax

Practice location:
  • Phone: 843-293-5610
  • Fax:
Mailing address:
  • Phone: 479-684-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP042862T
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-07742
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP046987T
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP038877T
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5429
License Number StateAR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: