Healthcare Provider Details

I. General information

NPI: 1205767753
Provider Name (Legal Business Name): MIRANDA WINGFIELD PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 WALNUT ST BLDG 3
WELLESLEY HILLS MA
02481-2108
US

IV. Provider business mailing address

116 PRINCETON ST
MEDFORD MA
02155-5952
US

V. Phone/Fax

Practice location:
  • Phone: 781-239-0100
  • Fax:
Mailing address:
  • Phone: 413-320-9893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL024969
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: