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NPI Code Detail

MEDICARE: ANDREW T MILES DPT

MEDICARE:   ANDREW T MILES  DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist008347KY
2225100000XPhysical TherapistCP011133TCO

General Provider Information

NPI Number : 1154096659
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW T MILES DPT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 814 S PERRY ST STE D
Second Line :
City : CASTLE ROCK
State : CO
Zip : 80104-1942
Country : US
Telephone Number : 303-814-2865
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2021
Last Update Date : 11/30/2023

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