Individual
MIRIAH LYN HUMPHREYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
9525 N BEACH ST STE 405, FORT WORTH, TX 76244-6438
(817) 502-7411
Mailing address
9525 N BEACH ST STE 405, FORT WORTH, TX 76244-6438
(817) 502-7411
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2131547
TX
Other
Enumeration date
09/09/2019
Last updated
09/09/2019
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