Individual
MARY A MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 FAIRGROUNDS RD, ELDON R-I AND SPECIAL LEARNING CENTER, JEFFERSON CITY, MO 65109-5443
(573) 392-8000
(573) 392-8080
Mailing address
1115 FAIRGROUNDS RD, JEFFERSON CITY, MO 65109-5443
(573) 392-8000
(573) 392-8080
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2002015973
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
487457608
—
MO
Enumeration date
04/19/2007
Last updated
02/20/2009
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