Healthcare Provider Details

I. General information

NPI: 1134939044
Provider Name (Legal Business Name): LINDSEY MAE MILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 ZANE AVE N
BROOKLYN PARK MN
55443-1400
US

IV. Provider business mailing address

2016 190TH ST
TRUMAN MN
56088-2077
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-6228
  • Fax:
Mailing address:
  • Phone: 507-848-6581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13760
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: