Healthcare Provider Details

I. General information

NPI: 1922922905
Provider Name (Legal Business Name): MYLES LOUIS GREGORY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WALNUT ST STE 100
LANSDALE PA
19446-1144
US

IV. Provider business mailing address

1000 WALNUT ST STE 100
LANSDALE PA
19446-1144
US

V. Phone/Fax

Practice location:
  • Phone: 267-810-3335
  • Fax: 267-810-3335
Mailing address:
  • Phone: 267-810-3335
  • Fax: 267-810-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: