Provider Demographics
NPI:1184758328
Name:MIETUS, JOEL M (PT)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:M
Last Name:MIETUS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:106 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3548
Mailing Address - Country:US
Mailing Address - Phone:972-256-3320
Mailing Address - Fax:972-256-1299
Practice Address - Street 1:4301 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6416
Practice Address - Country:US
Practice Address - Phone:972-256-3320
Practice Address - Fax:972-256-1299
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1108892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist