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General NPI Number Information
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NPI Number | 1235675307
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Entity Type | Organization
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Legal Business Name | MIRACLE MILE THERAPY LLC
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Dates
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Enumeration Date | 01/13/2017
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 2780 N FLORIDA AVE UNIT 1 HERNANDO PLAZA
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City | HERNANDO
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State | FL
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Zip | 34442-4390
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Country | US
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Telephone | 877-773-7123
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Fax | 877-773-7123
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Provider Business Mailing Address
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Address Line | 2780 N FLORIDA AVE STE 1
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City | HERNANDO
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State | FL
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Zip | 34442-4390
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Country | US
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Telephone | 877-773-7123
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Fax | 877-773-7123
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Authorized Official
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Title or Position | OWNER
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Name | CHERYL YARCHUK
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Credential | OTR/L, CLT
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Telephone | 315-534-3409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT18040
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License Number State | FL
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