MEDICARE: MIRI CHOE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1255784328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRI CHOE DPT

Provider Business Mailing Address
First Line	:	3200 CRAIN HWY
Second Line	:	SUITE 103
City	:	WALDORF
State	:	MD
Zip	:	20603-4841
Country	:	US
Telephone Number	:	240-419-5101
Fax Number	:	240-419-5106

Provider Business Practice Location Address
First Line	:	3200 CRAIN HWY
Second Line	:	SUITE 103
City	:	WALDORF
State	:	MD
Zip	:	20603-4841
Country	:	US
Telephone Number	:	240-419-5101
Fax Number	:	240-419-5106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/13/2016

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