Provider Demographics
NPI:1598776122
Name:MIRANDA, MAE HSING (PT, DPT, OCS)
Entity Type:Individual
Prefix:MRS
First Name:MAE
Middle Name:HSING
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:MRS
Other - First Name:MAE
Other - Middle Name:HSING
Other - Last Name:CISNEROZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, OCS
Mailing Address - Street 1:405 QUEEN ANNE CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6626
Mailing Address - Country:US
Mailing Address - Phone:210-827-2050
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-221-5033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12111812251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic