Individual
AMY MIKULEC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12930 CHIPPEWA RD, BRECKSVILLE, OH 44141-2100
(216) 409-1953
Mailing address
BANNER PHYSICAL THERAPY AND REHAB BOSWELL, 10503 W THUNDERBIRD BLVD SUITE 263A, SUN CITY, AZ 85351
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
017304
OH
225100000X
Physical Therapist
13677
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017304
OHIO PHYSICAL THERAPY LICENSE
OH
01
—
13677
MEDICARE
AZ
Enumeration date
05/25/2018
Last updated
08/31/2021
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