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General NPI Number Information
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NPI Number | 1134304314
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Entity Type | Organization
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Legal Business Name | MIRANDA PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 5815 N. BLACK CYN HWY 100
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City | PHOENIX
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State | AZ
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Zip | 85015-2200
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Country | US
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Telephone | 602-249-0607
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Fax | 602-249-0741
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Provider Business Mailing Address
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Address Line | 5815 N. BLACK CYN HWY 100
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City | PHOENIX
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State | AZ
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Zip | 85015-2200
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Country | US
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Telephone | 602-249-0607
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Fax | 602-249-0741
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID AARON MIRANDA
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Credential | MPT
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Telephone | 602-249-0607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 5061
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License Number State | AZ
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