Provider Demographics
NPI:1558936310
Name:MIERA, ERIC DOUGLAS
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DOUGLAS
Last Name:MIERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9308 KEMPLER DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6059
Mailing Address - Country:US
Mailing Address - Phone:505-688-3905
Mailing Address - Fax:
Practice Address - Street 1:5200 DAVIS LN BLDG A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-4071
Practice Address - Country:US
Practice Address - Phone:512-563-9566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2160988225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant