Provider Demographics
NPI:1346382306
Name:MIRANDA, HEATHER LEE (PT,DPT)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LEE
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:LEE
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:30 PECK RD STE 1101
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6123
Mailing Address - Country:US
Mailing Address - Phone:860-498-0867
Mailing Address - Fax:
Practice Address - Street 1:30 PECK RD STE 1101
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6123
Practice Address - Country:US
Practice Address - Phone:860-498-0867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02286225100000X
MA15207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist