Provider Demographics
NPI:1780136721
Name:ISON, MIAFLOR V (PT, DPT)
Entity type:Individual
Prefix:
First Name:MIAFLOR
Middle Name:V
Last Name:ISON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MIAFLOR
Other - Middle Name:G
Other - Last Name:VILLAMARIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3219 S ORANGE AVE APT 434
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6273
Mailing Address - Country:US
Mailing Address - Phone:407-627-9506
Mailing Address - Fax:
Practice Address - Street 1:3305 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6125
Practice Address - Country:US
Practice Address - Phone:407-904-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1266953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist