Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA29687 | FL |
NPI | 1003452210 |
---|---|
Provider Name | Sarah Miranda |
First Address | Deerfield Beach, FL 33064-2619 |
Second Address | Boca Raton, FL 33486-1089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2019 |
Last Update Date | 22/11/2019 |