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General NPI Number Information
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NPI Number | 1124696141
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Entity Type | Individual
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Provider Name | CALEB AARON MILES PTA
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Gender | Male
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 4707 BROADWAY
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City | SAN ANTONIO
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State | TX
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Zip | 78209-6215
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Country | US
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Telephone | 210-829-7561
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Fax |
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Provider Business Mailing Address
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Address Line | 770 N INTERSTATE 35 APT 1124
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City | NEW BRAUNFELS
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State | TX
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Zip | 78130-8407
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Country | US
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Telephone | 682-429-7970
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2155529
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License Number State | TX
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