Provider Demographics
NPI:1467483537
Name:MIEYAL, MIRANDA (PT)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:MIEYAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6403 ALBER AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-3409
Mailing Address - Country:US
Mailing Address - Phone:440-884-2574
Mailing Address - Fax:
Practice Address - Street 1:5700 LOMBARDO CTR
Practice Address - Street 2:ROCK RUN NORTH; SUITE 205
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-2540
Practice Address - Country:US
Practice Address - Phone:216-447-1149
Practice Address - Fax:216-520-3574
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist