Individual
MS. MIRANDA L BOURGEOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3301 BERRYWOOD DR, SUITE 204, COLUMBIA, MO 65201-6517
(573) 449-6082
Mailing address
3301 BERRYWOOD DR, SUITE 204, COLUMBIA, MO 65201-6517
(573) 449-6082
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2001001888
MO
225100000X
Physical Therapist
3407
IA
Other
Enumeration date
03/29/2007
Last updated
03/18/2015
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