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General NPI Number Information
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NPI Number | 1417575291
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Entity Type | Individual
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Provider Name | MIRANDA R GOEN PT, DPT, OCS
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Gender | Female
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 16037 TAMPA PALMS BLVD W STE C
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City | TAMPA
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State | FL
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Zip | 33647-2001
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Country | US
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Telephone | 813-542-8188
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Fax |
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Provider Business Mailing Address
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Address Line | 16037 TAMPA PALMS BLVD W STE C
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City | TAMPA
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State | FL
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Zip | 33647-2001
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Country | US
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Telephone | 813-542-8188
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Fax | 813-542-8196
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 38102
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License Number State | FL
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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 | 2305213562
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License Number State | VA
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