MEDICARE: M. T. VERONICA REYES MIRANDA-ADLER P.T.

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
1	225100000X	Physical Therapist	PT7212	FL

General Provider Information

NPI Number	:	1447313101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M. T. VERONICA REYES MIRANDA-ADLER P.T.

Provider Business Mailing Address
First Line	:	9744 SW 123RD TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-4934
Country	:	US
Telephone Number	:	305-255-5343
Fax Number	:	305-255-5343

Provider Business Practice Location Address
First Line	:	9744 SW 123RD TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-4934
Country	:	US
Telephone Number	:	305-255-5343
Fax Number	:	305-255-5343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2006
Last Update Date	:	07/08/2007

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