MEDICARE: MIRANDA KAY BESS PT, DPT, MBA

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	2021033632	MO

General Provider Information

NPI Number	:	1881579175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA KAY BESS PT, DPT, MBA

Provider Business Mailing Address
First Line	:	991 E 430TH RD
Second Line	:
City	:	BOLIVAR
State	:	MO
Zip	:	65613-8283
Country	:	US
Telephone Number	:	417-298-4964
Fax Number	:

Provider Business Practice Location Address
First Line	:	1323 S ASH ST
Second Line	:
City	:	BUFFALO
State	:	MO
Zip	:	65622-9311
Country	:	US
Telephone Number	:	417-298-4964
Fax Number	:

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

Provider Enumeration Date	:	08/07/2025
Last Update Date	:	08/07/2025

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