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General NPI Number Information
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NPI Number | 1558936310
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Entity Type | Individual
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Provider Name | ERIC DOUGLAS MIERA
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Gender | Male
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Dates
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Enumeration Date | 05/24/2021
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 5200 DAVIS LN BLDG A
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City | AUSTIN
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State | TX
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Zip | 78749-4071
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Country | US
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Telephone | 512-563-9566
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Fax |
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Provider Business Mailing Address
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Address Line | 9308 KEMPLER DR UNIT B
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City | AUSTIN
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State | TX
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Zip | 78748-6059
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Country | US
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Telephone | 505-688-3905
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2160988
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License Number State | TX
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