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General NPI Number Information
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NPI Number | 1548975741
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Entity Type | Individual
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Provider Name | TYKISHA NADINA MILES
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Gender | Female
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 123 E WRIGHT BLVD
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City | UNIVERSAL CITY
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State | TX
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Zip | 78148-4437
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Country | US
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Telephone | 210-347-3274
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Fax |
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Provider Business Mailing Address
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Address Line | 10228 COLONEL RDG
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City | SCHERTZ
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State | TX
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Zip | 78154-3481
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Country | US
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Telephone | 210-347-3274
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT135333
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License Number State | TX
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