| Doctor Name: | MIRANDA BOSS |
| NPI Number: | 1386078756 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPT, ATC |
| License Number: | 070-020103 |
| Business Practice Address: | 1258 W South St Suite 1 Kewanee, IL - 614438300 |
| Business Phone Number: | 3098522200 |
| Business Fax Number: | 8662458064 |
| Mailing Address: | Po Box 3497, STURTEVANT |
| State: | WI |
| Postal Code: | 531770300 |
| Phone Number: | 8882011040 |
| Fax Number: | 8662458064 |
| NPI Enumeration Date: | 08/21/2013 |
| NPI Last Update Date: | 10/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 070-020103 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| 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 |