Healthcare Provider Details

I. General information

NPI: 1407781677
Provider Name (Legal Business Name): MIRANDA GRACE COHN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 CHATEAU BLVD
PARAGOULD AR
72450-6264
US

IV. Provider business mailing address

4333 COUNTY ROAD 780
JONESBORO AR
72405-9455
US

V. Phone/Fax

Practice location:
  • Phone: 870-243-7597
  • Fax:
Mailing address:
  • Phone: 870-243-7597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4447
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: