Provider Demographics
NPI:1164977724
Name:MIRKOVIC, STOJAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:STOJAN
Middle Name:
Last Name:MIRKOVIC
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 JELLICOE AVE
Mailing Address - Street 2:
Mailing Address - City:ETOBICOKE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M8W 1W3
Mailing Address - Country:CA
Mailing Address - Phone:416-573-5324
Mailing Address - Fax:
Practice Address - Street 1:1755 WITTINGTON PL STE 175
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-1905
Practice Address - Country:US
Practice Address - Phone:866-221-5405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0014260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist