Provider Demographics
NPI:1194546937
Name:AGUILAR MIRON, JOSUE ISAAC (PTA)
Entity type:Individual
Prefix:
First Name:JOSUE
Middle Name:ISAAC
Last Name:AGUILAR MIRON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 3RD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-1074
Mailing Address - Country:US
Mailing Address - Phone:570-604-1903
Mailing Address - Fax:
Practice Address - Street 1:33 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1949
Practice Address - Country:US
Practice Address - Phone:570-208-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE013653225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant