Individual
MIRANDA MUSSACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
5215 W BASELINE RD STE 101, LAVEEN, AZ 85339-2943
(623) 219-4600
(623) 219-4601
Mailing address
5215 W BASELINE RD STE 101, LAVEEN, AZ 85339-2943
(623) 219-4600
(623) 219-4601
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
034596
AZ
Other
Enumeration date
03/17/2026
Last updated
03/17/2026
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