Healthcare Provider Details

I. General information

NPI: 1245490028
Provider Name (Legal Business Name): ERIC CHARLES MIRARCHI MPT, CRED. MDT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2008
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15543 N REEMS RD STE 133
SURPRISE AZ
85374-9582
US

IV. Provider business mailing address

17564 N 167TH DR
SURPRISE AZ
85374-6827
US

V. Phone/Fax

Practice location:
  • Phone: 623-975-5374
  • Fax: 623-214-9489
Mailing address:
  • Phone: 724-513-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-009285
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: