Healthcare Provider Details

I. General information

NPI: 1740282029
Provider Name (Legal Business Name): MILES SYKES DPT, MPT, OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3570 COLLEGE ST SUITE 150
BEAUMONT TX
77701-4683
US

IV. Provider business mailing address

2929 CALDER ST SUITE 100
BEAUMONT TX
77702-1845
US

V. Phone/Fax

Practice location:
  • Phone: 409-813-1920
  • Fax: 409-813-1486
Mailing address:
  • Phone: 409-813-1920
  • Fax: 409-813-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number105903
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1112530
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: