Provider Demographics
NPI:1205278520
Name:MIRAFLOR, NEIL (PT)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:MIRAFLOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21910 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4871
Mailing Address - Country:US
Mailing Address - Phone:313-757-1768
Mailing Address - Fax:
Practice Address - Street 1:21910 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-4871
Practice Address - Country:US
Practice Address - Phone:313-757-1768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist