Provider Demographics
NPI:1629774732
Name:MIRABILE, JANINE (PT)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:MIRABILE
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 1:650 MCHENRY RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-2607
Mailing Address - Country:US
Mailing Address - Phone:443-843-6320
Mailing Address - Fax:
Practice Address - Street 1:650 MCHENRY RD STE 1100
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2607
Practice Address - Country:US
Practice Address - Phone:443-843-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist