Provider Demographics
NPI:1699072082
Name:BARBOSA, MIRIAM
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:BARBOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 LADY ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3105
Mailing Address - Country:US
Mailing Address - Phone:803-758-5962
Mailing Address - Fax:
Practice Address - Street 1:911 LADY ST
Practice Address - Street 2:SUITE H
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3105
Practice Address - Country:US
Practice Address - Phone:803-758-5962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0000OtherNA