MEDICARE: MOLLY KIERSTEN MIKLES PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5543	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326046483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY KIERSTEN MIKLES PT

Provider Business Mailing Address
First Line	:	2850 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1910
Country	:	US
Telephone Number	:	520-322-6274
Fax Number	:	520-321-0495

Provider Business Practice Location Address
First Line	:	3988 E FORT LOWELL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1010
Country	:	US
Telephone Number	:	520-488-5291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/14/2022

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