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General NPI Number Information
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NPI Number | 1083267793
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Entity Type | Individual
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Provider Name | MIRANDA ROBLES DPT
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Gender | Female
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 970 FORT WAYNE AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-4328
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Country | US
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Telephone | 906-282-8314
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 GOLFVIEW DR
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-6620
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Country | US
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Telephone | 111-111-1111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05013533A
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License Number State | IN
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