Provider Demographics
NPI:1770516866
Name:MIELE, MARILYN A (RPT)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:A
Last Name:MIELE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5300 DERRY ST 2ND
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3576
Mailing Address - Country:US
Mailing Address - Phone:717-839-2110
Mailing Address - Fax:717-565-1934
Practice Address - Street 1:781 FAR HILLS DR
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW FREEDOM
Practice Address - State:PA
Practice Address - Zip Code:17349-8447
Practice Address - Country:US
Practice Address - Phone:717-235-9890
Practice Address - Fax:717-235-9894
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPT1462E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA201031331OtherTAX ID
PA201031331OtherTAX ID