Individual
MIRANDA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
25023 BOTHWELL PARK RD, SEDALIA, MO 65301-0084
(660) 827-3993
Mailing address
PO BOX 563, STOVER, MO 65078-0563
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2011011359
MO
Other
Enumeration date
08/30/2011
Last updated
08/30/2011
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