Provider Demographics
NPI:1316196470
Name:MIRISCH, MARC STEVEN (P T, DPT, MBA)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:STEVEN
Last Name:MIRISCH
Suffix:
Gender:M
Credentials:P T, DPT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16091 SAN DIEGUITO RD UNIT 8412
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-6773
Mailing Address - Country:US
Mailing Address - Phone:858-215-2063
Mailing Address - Fax:
Practice Address - Street 1:7469 LAS LUNAS
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3851
Practice Address - Country:US
Practice Address - Phone:858-215-2063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-14
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist