Active NPI
Mary Rebecca Miller, MSPT
- Physical Therapist
- Arnold, MO
National Provider Identifier
1104021823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2007000363
- Practice address
- 3950 Vogel Rd
Arnold, MO 63010-3790 - Phone
- (314) 842-2990
- Fax
- (314) 842-5162
- NPI assigned
- Jun 21, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2007000363 | MO | Primary |
Addresses
Primary practice location
3950 Vogel Rd
Arnold, MO 63010-3790
Mailing address
13537 Barrett Parkway Dr
Suite 105
Ballwin, MO 63021-5899
Phone (314) 821-9126
Other names 1
- Mary Rebecca Randall
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2007000363 | MO | MD | Physical Therapist |
Interoperability endpoints
- maryrebecca.miller.p2@direct.athleticoltd.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185408000000",
"number": "1104021823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13537 BARRETT PARKWAY DR",
"address_2": "SUITE 105",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630215899",
"telephone_number": "314-821-9126",
"fax_number": "314-821-9142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3950 VOGEL RD",
"city": "ARNOLD",
"state": "MO",
"postal_code": "630103790",
"telephone_number": "314-842-2990",
"fax_number": "314-842-5162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "MARY",
"middle_name": "REBECCA",
"credential": "MSPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-21",
"last_updated": "2007-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2007000363",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "RANDALL",
"middle_name": "REBECCA",
"credential": "MSPT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Arnold, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.