Gloria Daveda Miller
Individual provider Active NPI Physical Therapist · Kerens, TX
NPI 1386124642 · NPPES record last updated Aug 16, 2018
Key facts
- NPI
- 1386124642
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1204466 (TX)
- Practice address
- 809 NE 4TH St
Kerens, TX 75144-2715 - Phone
- (903) 396-3211
- NPI assigned
- Aug 16, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1204466 | TX | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1204466 | TX | Yes |
Addresses
Primary practice location
809 NE 4TH St
Kerens, TX 75144-2715
Mailing address
1709A Woodland PL
Corsicana, TX 75110-1010
Phone (815) 575-5281
Other providers in Kerens, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.