Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 18552 | AL |
NPI | 1053512590 |
---|---|
Provider Name | Leesa D Miles |
First Address | Birmingham, AL 35213 |
Second Address | Birmingham, AL 35233-2521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
515-34815 | PHYSICAL THERAPY PROVIDER (01) | AL |
515-34900 | PHYSICAL THERAPY PROVIDER (01) | AL |