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General NPI Number Information
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NPI Number | 1386124642
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Entity Type | Individual
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Provider Name | GLORIA DAVEDA MILLER
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Gender | Female
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 809 NE 4TH ST
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City | KERENS
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State | TX
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Zip | 75144-2715
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Country | US
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Telephone | 903-396-3211
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Fax |
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Provider Business Mailing Address
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Address Line | 1709A WOODLAND PL
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City | CORSICANA
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State | TX
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Zip | 75110-1010
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Country | US
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Telephone | 815-575-5281
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1204466
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License Number State | TX
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