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General NPI Number Information
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NPI Number | 1255144499
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Entity Type | Individual
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Provider Name | KARLA MIRANDA
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Gender | Female
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 43491 N COYOTE RD
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-8924
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Country | US
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Telephone | 602-421-7718
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 N ARIZONA AVE APT 1069
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City | CHANDLER
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State | AZ
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Zip | 85225-7197
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Country | US
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Telephone | 520-313-0159
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA-014536
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License Number State | AZ
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