Individual
MIRANDA MCGOFFIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2390 W CONGRESS ST, LAFAYETTE, LA 70506-4205
(337) 261-6700
Mailing address
3113 RICELAND RD, RAYNE, LA 70578-2717
(337) 257-3085
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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