Provider Demographics
NPI:1790221786
Name:POMIJE, MIRANDA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:POMIJE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-4627
Mailing Address - Country:US
Mailing Address - Phone:952-594-1104
Mailing Address - Fax:
Practice Address - Street 1:2351 HUDSON ROAD
Practice Address - Street 2:UNIVERSITY OF NORTHERN IOWA- ATHLETIC TRAINING
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613
Practice Address - Country:US
Practice Address - Phone:319-273-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0787612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer