Miranda Moncada-Sullivan, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501016790 Issued in MI

Practice address

3946 Blue Spruce Dr
Dewitt, MI 48820-9259

Phone

(989) 249-3915

NPI assigned

Feb 26, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Transform Physical Therapy and Wellness LLC

  • Physical Therapist
  • Dewitt, MI
  • NPI 1447990171

  Single Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1831690718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3946 BLUE SPRUCE DR",
            "city": "DEWITT",
            "state": "MI",
            "postal_code": "488209259",
            "telephone_number": "989-249-3915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3946 BLUE SPRUCE DR",
            "city": "DEWITT",
            "state": "MI",
            "postal_code": "488209259",
            "telephone_number": "989-249-3915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONCADA-SULLIVAN",
        "first_name": "MIRANDA",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-26",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501016790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael C Liddell DO PLLC
• Michigan Family Medicine and Urgent Care
• Jacklyn Anne Miller, AU.D.
• Kayleigh Miller
• Mission to Thrive LLC
• Kristen Mae Monroe, DNP, RN, FNP-BC
• Brian Moran
• Jacqueline Denise Moses, M.D.
• Abigail Karlene Mullins, BSN,RNC,LCCE,IBCLC
• Michael Murphy

• All providers in Dewitt, MI
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.