Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1304838 | TX |
N | 2251N0400X | Physical Therapist - Neurology |
NPI | 1144712019 |
---|---|
Provider Name | Patrick Alan Miles |
First Address | Bulverde, TX 78163-2507 |
Second Address | San Antonio, TX 78258-4072 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2018 |
Last Update Date | 17/03/2021 |