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NPI Code Detail

MEDICARE: DAVID V MIRANDA PT

MEDICARE: DAVID V MIRANDA PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist04493LA

General Provider Information

NPI Number : 1639264096
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID V MIRANDA PT
Provider Business Mailing Address
First Line : 2251 S BURNSIDE AVE
Second Line :
City : GONZALES
State : LA
Zip : 70737-4642
Country : US
Telephone Number : 225-644-0290
Fax Number : 225-644-4201
Provider Business Practice Location Address
First Line : 2251 S BURNSIDE AVE
Second Line :
City : GONZALES
State : LA
Zip : 70737-4642
Country : US
Telephone Number : 225-644-0290
Fax Number : 225-644-4201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 05/08/2018

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Directions to “ DAVID V MIRANDA PT” Practice Location

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