Doctor Name: | MARY A MIRANDA |
NPI Number: | 1427275999 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 2002015973 |
Business Practice Address: | 1115 Fairgrounds Rd Eldon R-i And Special Learning Center Jefferson City, MO - 651095443 |
Business Phone Number: | 5733928000 |
Business Fax Number: | 5733928080 |
Mailing Address: | 1115 Fairgrounds Rd, JEFFERSON CITY |
State: | MO |
Postal Code: | 651095443 |
Phone Number: | 5733928000 |
Fax Number: | 5733928080 |
NPI Enumeration Date: | 04/19/2007 |
NPI Last Update Date: | 02/20/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 2002015973 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
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 |