Provider Demographics
NPI:1205004041
Name:MARIANO, MIRA H (PT)
Entity Type:Individual
Prefix:DR
First Name:MIRA
Middle Name:H
Last Name:MARIANO
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:7419 GRANBY STREET
Mailing Address - Street 2:NORTH SHORE SPORTS & PHYSICAL THERAPY
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505
Mailing Address - Country:US
Mailing Address - Phone:757-489-5820
Mailing Address - Fax:757-489-5822
Practice Address - Street 1:7419 GRANBY STREET
Practice Address - Street 2:NORTH SHORE SPORTS & PHYSICAL THERAPY
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505
Practice Address - Country:US
Practice Address - Phone:757-489-5820
Practice Address - Fax:757-489-5822
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305005017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist