Individual
AMANDA KRISTAN MIRISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
100 E FERGUSON ST, TYLER, TX 75702-5759
(903) 509-2040
Mailing address
100 E FERGUSON ST, TYLER, TX 75702-5759
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
1401088
TX
Other
Enumeration date
01/16/2025
Last updated
01/16/2025
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