Doctor Name: | MIRANDA JOHNSON |
NPI Number: | 1568711893 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT, DPT |
License Number: | PT-3012 |
Business Practice Address: | 179 Sw 5th Avenue Meridian, ID - 836422995 |
Business Phone Number: | 2083678282 |
Business Fax Number: | 2083678288 |
Mailing Address: | 179 Sw 5th Avenue, MERIDIAN |
State: | ID |
Postal Code: | 836422995 |
Phone Number: | 2083678282 |
Fax Number: | 2083678288 |
NPI Enumeration Date: | 08/31/2012 |
NPI Last Update Date: | 08/31/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT-3012 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
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 |