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Individual

ERIC RICHARD MIELKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1050 OLD CAMP RD STE 282, THE VILLAGES, FL 32162-1762
(763) 267-3209
Mailing address
11416 ROMA RD, OXFORD, FL 34484-3593
(763) 267-3209

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
30270
FL
225200000X
Physical Therapy Assistant
A2463
MN
2255A2300X
Athletic Trainer
2889
MN

Other

Enumeration date
11/08/2020
Last updated
11/08/2020
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