Individual
MRS. JEANETTE LYNN DE MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
1 LAREDO PL, DAVIE, FL 33324-5514
(954) 382-0286
Mailing address
1 LAREDO PL, DAVIE, FL 33324-5514
(954) 382-0286
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA19844
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA19844
STATE LICENSE
FL
Enumeration date
04/26/2007
Last updated
07/08/2007
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