Miranda Boss, DPT, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070-020103 Issued in IL

Practice address

1258 W South St
Suite 1
Kewanee, IL 61443-8300

Phone

(309) 852-2200

Fax

(866) 245-8064

NPI assigned

Aug 21, 2013

Last updated

Oct 29, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miranda Murray Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kewanee Physical Therapy and Rehab Specialists

  • Physical Therapist
  • Kewanee, IL
  • NPI 1376659714
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383004800000",
    "number": "1386078756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3497",
            "city": "STURTEVANT",
            "state": "WI",
            "postal_code": "531770300",
            "telephone_number": "888-201-1040",
            "fax_number": "866-245-8064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1258 W SOUTH ST",
            "address_2": "SUITE 1",
            "city": "KEWANEE",
            "state": "IL",
            "postal_code": "614438300",
            "telephone_number": "309-852-2200",
            "fax_number": "866-245-8064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSS",
        "first_name": "MIRANDA",
        "credential": "DPT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-21",
        "last_updated": "2013-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-020103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "MURRAY",
            "credential": "DPT, ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Kewanee, IL
• Providers in Kewanee, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.