Provider Demographics
NPI:1134476401
Name:RAMIREZ, MYCHAEL RAY (PT)
Entity Type:Individual
Prefix:
First Name:MYCHAEL
Middle Name:RAY
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 N STATE HIGHWAY 360
Mailing Address - Street 2:1237
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-7871
Mailing Address - Country:US
Mailing Address - Phone:956-342-5392
Mailing Address - Fax:
Practice Address - Street 1:3824 S CARRIER PKWY
Practice Address - Street 2:SUITE 470
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-6644
Practice Address - Country:US
Practice Address - Phone:972-262-9972
Practice Address - Fax:972-262-9986
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1218819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist