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NPI Code Detail

MEDICARE: MIRANDA L FAWCETT PTA

MEDICARE: MIRANDA L FAWCETT PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2062937TX

General Provider Information

NPI Number : 1336412170
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA L FAWCETT PTA
Provider Business Mailing Address
First Line : 1301 E HOUSTON ST
Second Line :
City : BEEVILLE
State : TX
Zip : 78102-5309
Country : US
Telephone Number : 361-362-1700
Fax Number : 361-362-1369
Provider Business Practice Location Address
First Line : 1301 E HOUSTON ST
Second Line :
City : BEEVILLE
State : TX
Zip : 78102-5309
Country : US
Telephone Number : 361-362-1700
Fax Number : 361-362-1369
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2012
Last Update Date : 02/09/2012

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Directions to “ MIRANDA L FAWCETT PTA” Practice Location

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