Provider Demographics
NPI:1164728978
Name:MIRANDA, JOSEPH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NORTH AVE E
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2491
Mailing Address - Country:US
Mailing Address - Phone:908-276-0237
Mailing Address - Fax:908-276-5692
Practice Address - Street 1:210 NORTH AVE E
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2491
Practice Address - Country:US
Practice Address - Phone:908-276-0237
Practice Address - Fax:908-276-5692
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01384800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist