Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 293178 | CA |
NPI | 1174047815 |
---|---|
Provider Name | Derek Lee Miles |
First Address | Mountain View, CA 94040-2824 |
Second Address | Sunnyvale, CA 94087-3832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2017 |
Last Update Date | 02/08/2017 |