Healthcare Provider Details

I. General information

NPI: 1720632854
Provider Name (Legal Business Name): PAUL EDWARD MILES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4741 W 229TH ST
FAIRVIEW PARK OH
44126-2440
US

IV. Provider business mailing address

4741 W 229TH ST
FAIRVIEW PARK OH
44126-2440
US

V. Phone/Fax

Practice location:
  • Phone: 440-382-2122
  • Fax:
Mailing address:
  • Phone: 440-382-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT022324
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT006605
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: