Groenendaal, Mirian W
Groenendaal, Mirian W is an individual health care provider with primary practice located at 1957 Thompson Rd. , Coos Bay OR 97420-2031. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Groenendaal, Mirian W can be contacted via phone (541) 266-7050.Contact Information
Primary practice address
1957 Thompson Rd.
Coos Bay OR 97420-2031
Phone: (541) 266-7050
Fax: (541) 266-0180
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | 1813 | Oregon |
Profile Details
| NPI number | 1124164678 |
|---|---|
| LBN Legal business name | Groenendaal, Mirian W |
| Credentials | Physical Therapist (PT) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 30th, 2007 |
| Last updated | May 18th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124164678 | NPPES |
| Oregon | MEDICAID | 182751 | |
| Oregon | Other | 410254301 |
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