Provider Demographics
NPI:1881185312
Name:MIELKE, VALERIE JANE (ATC)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:JANE
Last Name:MIELKE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9745 HERONS NEST CT APT 302
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5277
Mailing Address - Country:US
Mailing Address - Phone:920-680-4166
Mailing Address - Fax:
Practice Address - Street 1:2850 N FEDERAL HWY FL 2
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6849
Practice Address - Country:US
Practice Address - Phone:954-942-0321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL46942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer