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Individual

KASEY ANNE MIRANDA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
600 E GARFIELD ST, IOLA, KS 66749-2034
(620) 365-3183
Mailing address
1112 COLONIAL DR, ALABASTER, AL 35007-8001
(205) 902-9431

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
14-03957
KS
225200000X
Physical Therapy Assistant
Primary
PTA9427
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
EDU837505499
BCBS PEEHIP
AL
Enumeration date
02/10/2022
Last updated
02/10/2022
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