Provider Demographics
NPI:1740436906
Name:MIRANDA, LEMUEL S (RPT)
Entity type:Individual
Prefix:
First Name:LEMUEL
Middle Name:S
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3481 BRANDON ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4540
Mailing Address - Country:US
Mailing Address - Phone:626-354-8264
Mailing Address - Fax:
Practice Address - Street 1:1663 BEVERLY BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5747
Practice Address - Country:US
Practice Address - Phone:213-250-0078
Practice Address - Fax:213-250-5578
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist