MEDICARE: MIRON NEIL FERRER

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
1	225100000X	Physical Therapist	293939	CA
2	225100000X	Physical Therapist	033619	AZ

General Provider Information

NPI Number	:	1619479284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRON NEIL FERRER

Provider Business Mailing Address
First Line	:	1978 ELEVATE WAY
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-3299
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	37200 N GANTZEL RD STE 260
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85140-7387
Country	:	US
Telephone Number	:	480-690-8080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	07/29/2024

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Directions to “ MIRON NEIL FERRER ” Practice Location

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