Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA002375 | GA |
NPI | 1003002619 |
---|---|
Provider Name | Danielle N Miles |
First Address | Griffin, GA 30224-0047 |
Second Address | Griffin, GA 30224-4214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2007 |
Last Update Date | 22/10/2008 |