Provider Demographics
NPI:1417829763
Name:MIRVIL, PATRICE
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:MIRVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 ROTONDA CIR
Mailing Address - Street 2:
Mailing Address - City:ROTONDA WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33947-2127
Mailing Address - Country:US
Mailing Address - Phone:682-225-5561
Mailing Address - Fax:941-460-4494
Practice Address - Street 1:1116 ROTONDA CIR
Practice Address - Street 2:
Practice Address - City:ROTONDA WEST
Practice Address - State:FL
Practice Address - Zip Code:33947-2127
Practice Address - Country:US
Practice Address - Phone:682-225-5561
Practice Address - Fax:941-460-4494
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA28814225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant