Provider Demographics
NPI:1790087815
Name:PEKAREK, MIRIAM LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:LYNN
Last Name:PEKAREK
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 1:36855 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4128
Mailing Address - Country:US
Mailing Address - Phone:440-942-4358
Mailing Address - Fax:440-954-8379
Practice Address - Street 1:36855 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4128
Practice Address - Country:US
Practice Address - Phone:440-942-4365
Practice Address - Fax:440-954-8379
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist