Provider Demographics
NPI:1497924344
Name:MIETUS PT, LLC
Entity Type:Organization
Organization Name:MIETUS PT, LLC
Other - Org Name:MIETUS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIETUS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-256-3320
Mailing Address - Street 1:4301 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6416
Mailing Address - Country:US
Mailing Address - Phone:972-256-3320
Mailing Address - Fax:972-256-1299
Practice Address - Street 1:4301 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6416
Practice Address - Country:US
Practice Address - Phone:972-256-3320
Practice Address - Fax:972-256-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy