Provider Demographics
NPI:1760687362
Name:VALINO-PAK, MIRAFLOR (PT)
Entity Type:Individual
Prefix:
First Name:MIRAFLOR
Middle Name:
Last Name:VALINO-PAK
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 1:9393 TIMBERWILDE DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77808-7557
Mailing Address - Country:US
Mailing Address - Phone:979-731-8762
Mailing Address - Fax:
Practice Address - Street 1:9393 TIMBERWILDE DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77808-7557
Practice Address - Country:US
Practice Address - Phone:979-731-8762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist