Individual
MS. CAROL MARTHA MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Contact information
Practice address
N27W5707 LINCOLN BLVD, CEDARBURG, WI 53012-2852
(262) 376-7676
Mailing address
W69N533 MARGIE LN, CEDARBURG, WI 53012-1801
(262) 375-0420
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
1032-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40309100
—
WI
Enumeration date
05/22/2007
Last updated
07/08/2007
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