Marco I Mirnics, DPT | |
1585 3rd St, Fort Johnson, LA 71459-5102 | |
(615) 609-1424 | |
Not Available |
Full Name | Marco I Mirnics |
---|---|
Gender | Male |
Speciality | Physical Therapist |
Location | 1585 3rd St, Fort Johnson, Louisiana |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1033893284 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 2305215674 (Virginia) | Primary |
Provider Name | Jackson Clinics Limited Partnership |
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Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1639594831 PECOS PAC ID: 2860623295 Enrollment ID: O20140327000554 |
Mailing Address | Practice Location Address |
---|---|
Marco I Mirnics, DPT 1585 3rd St, Fort Johnson, LA 71459-5102 Ph: (615) 609-1424 | Marco I Mirnics, DPT 1585 3rd St, Fort Johnson, LA 71459-5102 Ph: (615) 609-1424 |
Caleb O Johnson, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1585 3rd St, Fort Johnson, LA 71459 Phone: 337-531-3119 | |
Gunner Coleman, DPT, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1585 3rd St, Fort Johnson, LA 71459 Phone: 337-531-3517 | |
Shelby Landrum, PT Physical Therapist Medicare: Medicare Enrolled Practice Location: 1585 3rd St, Fort Johnson, LA 71459 Phone: 337-531-3207 |