Healthcare Provider Details

I. General information

NPI: 1184133522
Provider Name (Legal Business Name): MIRANDA SEAMONS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 BOISE AVE
LOVELAND CO
80538-4204
US

IV. Provider business mailing address

1977 DEWAR DR STE J
ROCK SPRINGS WY
82901-5757
US

V. Phone/Fax

Practice location:
  • Phone: 970-663-0815
  • Fax:
Mailing address:
  • Phone: 307-382-3228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0014239
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0942
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: