Individual
MIRANDA MARIE HERMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2305 SAN LUIS PLACE, GREEN BAY, WI 54304-5211
(920) 494-2817
(920) 494-2855
Mailing address
2305 SAN LUIS PLACE, GREEN BAY, WI 54304-5211
(920) 494-2817
(920) 494-2855
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2213-19
WI
Other
Enumeration date
12/29/2014
Last updated
12/29/2014
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