Active NPI
Elizabeth Anne Miotke, ATC,LAT,PTA
- Athletic Trainer
- Lafayette, IN
National Provider Identifier
1720352115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36000966A
- Practice address
- 3923 Prange Dr
Lafayette, IN 47905-4143 - Phone
- (765) 426-4173
- NPI assigned
- Mar 2, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 06002912A | IN | |
| Athletic Trainer | 2255A2300X | 36000966A | IN | Primary |
Addresses
Primary practice location
3923 Prange Dr
Lafayette, IN 47905-4143
Mailing address
3923 Prange Dr
Lafayette, IN 47905-4143
Phone (765) 426-4173
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06002912A | IN | MD | Physical Therapy Assistant |
| 36000966A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330646400000",
"number": "1720352115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3923 PRANGE DR",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479054143",
"telephone_number": "765-426-4173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3923 PRANGE DR",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479054143",
"telephone_number": "765-426-4173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIOTKE",
"first_name": "ELIZABETH",
"middle_name": "ANNE",
"name_prefix": "Mrs.",
"credential": "ATC,LAT,PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-03-02",
"last_updated": "2012-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "06002912A",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36000966A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.