Provider Demographics
NPI:1649397431
Name:MIRANDA, JEAN A (PT)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:A
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 CLYDESDALE DR
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-5811
Mailing Address - Country:US
Mailing Address - Phone:215-794-2067
Mailing Address - Fax:215-794-0279
Practice Address - Street 1:30 N SUGAN RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938-1893
Practice Address - Country:US
Practice Address - Phone:267-614-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005400L225100000X
PADAPT004191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist