Healthcare Provider Details

I. General information

NPI: 1730369398
Provider Name (Legal Business Name): MIRANDA JEAN BARKER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRANDA JEAN GOINGS M.S. P.T.

II. Dates (important events)

Enumeration Date: 11/11/2007
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CELEBRATION PL SUITE 200C
CELEBRATION FL
34747-4970
US

IV. Provider business mailing address

400 CELEBRATION PL SUITE 200C
CELEBRATION FL
34747-4970
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-4003
  • Fax: 407-303-4303
Mailing address:
  • Phone: 407-303-4003
  • Fax: 407-303-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT011958
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22159
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2744
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305205005
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: