Provider Demographics
NPI:1184133522
Name:SEAMONS, MIRANDA (PTA)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:SEAMONS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 DEWAR DR
Mailing Address - Street 2:STE J
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5757
Mailing Address - Country:US
Mailing Address - Phone:307-382-3228
Mailing Address - Fax:
Practice Address - Street 1:1708 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4204
Practice Address - Country:US
Practice Address - Phone:970-663-0815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014239225200000X
WY0942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant