Healthcare Provider Details

I. General information

NPI: 1073222899
Provider Name (Legal Business Name): KEESHIA MILES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14017 N EASTERN AVE
EDMOND OK
73013-5586
US

IV. Provider business mailing address

14017 N EASTERN AVE
EDMOND OK
73013-5586
US

V. Phone/Fax

Practice location:
  • Phone: 405-478-5333
  • Fax: 405-478-5334
Mailing address:
  • Phone: 405-478-5333
  • Fax: 405-478-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6226
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: