Provider Demographics
NPI:1760858070
Name:MIROCHA, PATRICK (ATC)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:MIROCHA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 E RIVER FALCONS WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32833-2779
Mailing Address - Country:US
Mailing Address - Phone:407-956-8550
Mailing Address - Fax:
Practice Address - Street 1:650 E RIVER FALCONS WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32833-2779
Practice Address - Country:US
Practice Address - Phone:407-956-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 31972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer