MEDICARE: MR. JOAL BERNARD MILES P.T.

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
1	225100000X	Physical Therapist	6059	CA

General Provider Information

NPI Number	:	1336121227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOAL BERNARD MILES P.T.

Provider Business Mailing Address
First Line	:	PO BOX 717
Second Line	:
City	:	ETNA
State	:	CA
Zip	:	96027-0717
Country	:	US
Telephone Number	:	530-467-5800
Fax Number	:	530-467-5808

Provider Business Practice Location Address
First Line	:	450 PIG ALLEY
Second Line	:
City	:	ETNA
State	:	CA
Zip	:	96027-9998
Country	:	US
Telephone Number	:	530-467-5800
Fax Number	:	530-467-5808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/16/2018

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