Provider Demographics
NPI:1053536342
Name:MILLER, DEANNA J (PT, MPT, PCS)
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT, MPT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9068 PRIVATE ROAD 6421
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-6693
Mailing Address - Country:US
Mailing Address - Phone:417-543-2744
Mailing Address - Fax:417-256-1584
Practice Address - Street 1:9068 PRIVATE ROAD 6421
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-6693
Practice Address - Country:US
Practice Address - Phone:417-543-2744
Practice Address - Fax:417-256-1584
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060021782251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics