Provider Demographics
NPI:1861531956
Name:MIRANDA, FERNANDO (RPT)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4887 LEHTO LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-5338
Mailing Address - Country:US
Mailing Address - Phone:561-317-1872
Mailing Address - Fax:561-968-6692
Practice Address - Street 1:4887 LEHTO LN
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-5338
Practice Address - Country:US
Practice Address - Phone:561-317-1872
Practice Address - Fax:561-968-6692
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4850ZMedicare ID - Type Unspecified