Provider Demographics
NPI:1295561264
Name:CASAREZ, MIRANDA ISABEL (DPT)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ISABEL
Last Name:CASAREZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E HARRISON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-9136
Mailing Address - Country:US
Mailing Address - Phone:956-230-6121
Mailing Address - Fax:956-230-3010
Practice Address - Street 1:1300 WILDROSE LN
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8600
Practice Address - Country:US
Practice Address - Phone:956-542-2845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1400315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist