| Doctor Name: | MRS. MIRIAM MCKIERNAN TRIBBETT |
| NPI Number: | 1083764096 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 05002083A |
| Business Practice Address: | 801 E Lasalle Ave South Bend, IN - 46617 |
| Business Phone Number: | 5742377863 |
| Business Fax Number: | 5744726294 |
| Mailing Address: | 801 E Lasalle Ave, SOUTH BEND |
| State: | IN |
| Postal Code: | 46617 |
| Phone Number: | 5742377863 |
| Fax Number: | 5744726294 |
| NPI Enumeration Date: | 01/11/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 05002083A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |