Provider Demographics
NPI:1285305854
Name:MIRANTE, KYRA (LMBT)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:MIRANTE
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 GRESHAM AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4208
Mailing Address - Country:US
Mailing Address - Phone:206-499-0803
Mailing Address - Fax:
Practice Address - Street 1:716 15TH ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3902
Practice Address - Country:US
Practice Address - Phone:919-294-6723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19786225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19786OtherMASSAGE AND BODYWORK LICENSE