Healthcare Provider Details

I. General information

NPI: 1437088028
Provider Name (Legal Business Name): ROBERT MIRALLES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 CHURN CREEK RD
REDDING CA
96002-0236
US

IV. Provider business mailing address

2991 HOWARD DR
REDDING CA
96001-6104
US

V. Phone/Fax

Practice location:
  • Phone: 530-646-4242
  • Fax:
Mailing address:
  • Phone: 530-227-2683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: