Provider Demographics
NPI:1194805853
Name:MIRACLE, JOE RHODES (CRTT)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:RHODES
Last Name:MIRACLE
Suffix:
Gender:M
Credentials:CRTT
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Mailing Address - Street 1:3687 MARSH PARK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2066
Mailing Address - Country:US
Mailing Address - Phone:904-807-9120
Mailing Address - Fax:904-807-9087
Practice Address - Street 1:3721 SANJOSE PLACE
Practice Address - Street 2:SUITE NUMBER 5
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257
Practice Address - Country:US
Practice Address - Phone:904-880-6551
Practice Address - Fax:904-880-6552
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLTT 8185227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1290150001Medicare NSC