Provider Demographics
NPI:1851571343
Name:MIRANDA, MARIA ELISA (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELISA
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 1:3692 E SAM HOUSTON PKWY S
Mailing Address - Street 2:STE 101
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3137
Mailing Address - Country:US
Mailing Address - Phone:281-487-1760
Mailing Address - Fax:281-487-1762
Practice Address - Street 1:3692 E SAM HOUSTON PKWY S
Practice Address - Street 2:STE 101
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3137
Practice Address - Country:US
Practice Address - Phone:281-487-1760
Practice Address - Fax:281-487-1762
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPT1038099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89579TOtherBCBS
TX83535EMedicare PIN