MEDICARE: MIRANDA ANSELMO LMT

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	225700000X	Massage Therapist	MT-50329	AZ

General Provider Information

NPI Number	:	1972456341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA ANSELMO LMT

Provider Business Mailing Address
First Line	:	2947 S PANTANO EDGE DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85730-2049
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 W PRINCE RD STE 4
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-3714
Country	:	US
Telephone Number	:	520-887-2228
Fax Number	:

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

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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Directions to “ MIRANDA ANSELMO LMT” Practice Location

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