Provider Demographics
NPI:1053424804
Name:BEDNAR, MIRANDA LEIGH (MSPT)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LEIGH
Last Name:BEDNAR
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4622 HARWICH RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-1605
Mailing Address - Country:US
Mailing Address - Phone:717-671-1004
Mailing Address - Fax:
Practice Address - Street 1:2850 COMMERCE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9383
Practice Address - Country:US
Practice Address - Phone:717-541-4348
Practice Address - Fax:717-541-9576
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102451PX9Medicare PIN