Provider Demographics
NPI:1508332263
Name:MIRANDA-RISNES, CORINA (LMT)
Entity Type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:MIRANDA-RISNES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HUDSON VIEW HL
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-3328
Mailing Address - Country:US
Mailing Address - Phone:347-239-5240
Mailing Address - Fax:
Practice Address - Street 1:49 HUDSON VIEW HL
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-3328
Practice Address - Country:US
Practice Address - Phone:347-239-5240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023211-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist