Provider Demographics
NPI:1255972998
Name:HISKEN, MIRTILA MARIA (PT)
Entity type:Individual
Prefix:
First Name:MIRTILA
Middle Name:MARIA
Last Name:HISKEN
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 1:4637 W EASTWIND DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-1220
Mailing Address - Country:US
Mailing Address - Phone:813-545-1124
Mailing Address - Fax:
Practice Address - Street 1:38250 A AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-5759
Practice Address - Country:US
Practice Address - Phone:813-782-5508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist