Provider Demographics
NPI:1083160311
Name:KWON, MIRAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:MIRAN
Middle Name:
Last Name:KWON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WASHINGTON ST STE C
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6873
Mailing Address - Country:US
Mailing Address - Phone:617-879-1599
Mailing Address - Fax:617-879-1607
Practice Address - Street 1:320 WASHINGTON ST STE C
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6873
Practice Address - Country:US
Practice Address - Phone:617-879-1599
Practice Address - Fax:617-879-1607
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist