Provider Demographics
NPI:1467828012
Name:MARSH, MIRANDA (DPT)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:MARSH
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 1:147 COUNTY RD STE 103A
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-4536
Mailing Address - Country:US
Mailing Address - Phone:401-643-1776
Mailing Address - Fax:
Practice Address - Street 1:147 COUNTY RD STE 103A
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-4536
Practice Address - Country:US
Practice Address - Phone:401-643-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist