Provider Demographics
NPI:1437938669
Name:MIRELLE, STELLA K (PT)
Entity Type:Individual
Prefix:DR
First Name:STELLA
Middle Name:K
Last Name:MIRELLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:STELLA
Other - Middle Name:K
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 877
Mailing Address - Street 2:
Mailing Address - City:TABERNASH
Mailing Address - State:CO
Mailing Address - Zip Code:80478-0202
Mailing Address - Country:US
Mailing Address - Phone:303-726-4561
Mailing Address - Fax:
Practice Address - Street 1:9001 W 130TH ST
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-1011
Practice Address - Country:US
Practice Address - Phone:440-237-3104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0008368225100000X
OHPT020630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist