Provider Demographics
NPI:1881579175
Name:BESS, MIRANDA KAY (PT, DPT, MBA)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:KAY
Last Name:BESS
Suffix:
Gender:F
Credentials:PT, DPT, MBA
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:
Other - Last Name:BESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:991 E 430TH RD
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-8283
Mailing Address - Country:US
Mailing Address - Phone:417-298-4964
Mailing Address - Fax:
Practice Address - Street 1:1323 S ASH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MO
Practice Address - Zip Code:65622-9311
Practice Address - Country:US
Practice Address - Phone:417-298-4964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021033632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist