Individual
MRS. ELIZABETH ANNE MIOTKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC,LAT,PTA
Contact information
Practice address
3923 PRANGE DR, LAFAYETTE, IN 47905-4143
(765) 426-4173
Mailing address
3923 PRANGE DR, LAFAYETTE, IN 47905-4143
(765) 426-4173
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
06002912A
IN
2255A2300X
Athletic Trainer
Primary
36000966A
IN
Other
Enumeration date
03/02/2012
Last updated
03/02/2012
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