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NPI Code Detail

MEDICARE: MRS. ROCHELLE GROSPE MIRANDA P.T.

MEDICARE: MRS. ROCHELLE GROSPE MIRANDA 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
1225100000XPhysical TherapistPT 10089FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Y4846OTHERFLBCBS

General Provider Information

NPI Number : 1922114065
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ROCHELLE GROSPE MIRANDA P.T.
Provider Business Mailing Address
First Line : 6144 GAZEBO PARK PL S STE 211
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-1086
Country : US
Telephone Number : 904-551-3122
Fax Number : 904-551-3481
Provider Business Practice Location Address
First Line : 6144 GAZEBO PARK PL S STE 211
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-1086
Country : US
Telephone Number : 904-551-3122
Fax Number : 904-551-3481
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2006
Last Update Date : 11/06/2012

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Directions to “ MRS. ROCHELLE GROSPE MIRANDA P.T.” Practice Location

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