Provider Demographics
NPI:1942093919
Name:MIRANDA BELANDRIA, MARCO ANTONIO (DPT)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:ANTONIO
Last Name:MIRANDA BELANDRIA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:205 LEE ST APT 510
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2951
Mailing Address - Country:US
Mailing Address - Phone:787-590-6767
Mailing Address - Fax:
Practice Address - Street 1:2730 UNIVERSITY BLVD W STE 812
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-1977
Practice Address - Country:US
Practice Address - Phone:240-292-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MD30442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist