Individual ProviderMiranda Marie HermesPhysical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address2305 San Luis Place, Green Bay, WI 54304-5211(920) 494-2817PECOS EnrollmentBased on the most recent information from CMS, provider Miranda Marie Hermes does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1619365681Provider TypeIndividualFull NameHermes, Miranda MarieCredentialPTAGenderFemaleSole ProprietorNoEnumeration Date12/29/2014Last Updated12/29/2014Contact InformationPractice LocationPractice Address2305 San Luis Place, Green Bay, WI 54304-5211Phone(920) 494-2817Fax(920) 494-2855Mailing LocationMailing Address2305 San Luis Place, Green Bay, WI 54304-5211Phone(920) 494-2817Fax(920) 494-2855Provider TaxonomiesCodeDescriptionLicenseCode225200000XPrimaryDescriptionPhysical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense2213-19Wisconsin