Individual
GLENN MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1903 E FIR AVE, STE. 102, FRESNO, CA 93720-3862
(559) 322-1703
(559) 322-1793
Mailing address
1903 E FIR AVE, STE. 102, FRESNO, CA 93720-3862
(559) 322-1703
(559) 322-1793
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
39881
CA
Other
Enumeration date
03/12/2013
Last updated
03/12/2013
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