Individual
MATT M MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1919 CHESTNUT ST STE 104, PHILADELPHIA, PA 19103-3456
(215) 564-1110
Mailing address
805 N LAWRENCE ST, PHILADELPHIA, PA 19123-2109
(609) 332-3908
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TE011900
PA
Other
Enumeration date
08/24/2018
Last updated
08/24/2018
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