Doctor Name: | MS. KELLY MIRANDA |
NPI Number: | 1578671558 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C, MPT |
License Number: | PT23425 |
Business Practice Address: | 26520 Cactus Ave Moreno Valley, CA - 925553927 |
Business Phone Number: | 9514864698 |
Business Fax Number: | |
Mailing Address: | 2358 Shadow Hill Dr, RIVERSIDE |
State: | CA |
Postal Code: | 925063462 |
Phone Number: | 9513691675 |
Fax Number: | |
NPI Enumeration Date: | 08/29/2006 |
NPI Last Update Date: | 10/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT23425 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
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 |