Provider Demographics
NPI:1982620472
Name:MIELCARSKI, SAMUEL ARTHUR (PT)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ARTHUR
Last Name:MIELCARSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 BELLS FERRY RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102
Mailing Address - Country:US
Mailing Address - Phone:678-214-0100
Mailing Address - Fax:
Practice Address - Street 1:5505 BELLS FERRY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102
Practice Address - Country:US
Practice Address - Phone:678-214-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist