Provider Demographics
NPI:1639974249
Name:MIREE, ELON
Entity type:Individual
Prefix:MS
First Name:ELON
Middle Name:
Last Name:MIREE
Suffix:
Gender:
Credentials:
Other - Prefix:DR
Other - First Name:ELON
Other - Middle Name:
Other - Last Name:MIREE D-MIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 231321
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-1321
Mailing Address - Country:US
Mailing Address - Phone:334-492-2486
Mailing Address - Fax:678-401-0228
Practice Address - Street 1:2424 E SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2546
Practice Address - Country:US
Practice Address - Phone:334-651-0248
Practice Address - Fax:678-401-0228
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner