Individual
MIRANDA MCGOFFIN
Active
Individual
MIRANDA MCGOFFIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
07317
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07317
PHYSICAL THERAPIST
LA
Enumeration date
11/19/2018
Last updated
11/19/2018
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