Provider Demographics
NPI:1801164868
Name:MIRRA, SMARO (PT)
Entity type:Individual
Prefix:MRS
First Name:SMARO
Middle Name:
Last Name:MIRRA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 PROSPECT PARK SW
Mailing Address - Street 2:APT 3A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5961
Mailing Address - Country:US
Mailing Address - Phone:917-747-1496
Mailing Address - Fax:347-599-1973
Practice Address - Street 1:1 PROSPECT PARK SW
Practice Address - Street 2:APT 3A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5961
Practice Address - Country:US
Practice Address - Phone:917-747-1496
Practice Address - Fax:347-599-1973
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY025606-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics