MEDICARE: KATHLEEN M MILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1336645266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN M MILES

Provider Business Mailing Address
First Line	:	601 LAGRANGE ST
Second Line	:
City	:	SOUTH HAVEN
State	:	MI
Zip	:	49090-1834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 PHILLIPS ST
Second Line	:
City	:	SOUTH HAVEN
State	:	MI
Zip	:	49090-1845
Country	:	US
Telephone Number	:	269-637-5147
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2018
Last Update Date	:	03/31/2018

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