Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 027354 | NY |
N | 2251G0304X | Physical Therapist - Geriatrics | 027354 | NY |
N | 2251P0200X | Physical Therapist - Pediatrics | 027354 | NY |
N | 2251S0007X | Physical Therapist - Sports | 027354 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 027354 | NY |
NPI | 1003973249 |
---|---|
Provider Name | Laura N Miranda |
First Address | New York, NY 10011-8202 |
Second Address | New York, NY 10011-8202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027354 | NY LICENSE NUMBER (01) | NY |