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NPI Code Detail

MEDICARE: MRS. MIRIAM LYNN PEKAREK PT

MEDICARE:  MRS. MIRIAM LYNN PEKAREK  PT
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
1225100000XPhysical Therapist003920OH

General Provider Information

NPI Number : 1790087815
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MIRIAM LYNN PEKAREK PT
Provider Business Mailing Address
First Line : 36855 RIDGE RD
Second Line :
City : WILLOUGHBY
State : OH
Zip : 44094-4128
Country : US
Telephone Number : 440-942-4358
Fax Number : 440-954-8379
Provider Business Practice Location Address
First Line : 36855 RIDGE RD
Second Line :
City : WILLOUGHBY
State : OH
Zip : 44094-4128
Country : US
Telephone Number : 440-942-4365
Fax Number : 440-954-8379
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2010
Last Update Date : 08/29/2012

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Directions to “ MRS. MIRIAM LYNN PEKAREK PT” Practice Location

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