Provider Demographics
NPI:1144712019
Name:MILES, PATRICK ALAN (PT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ALAN
Last Name:MILES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5557 BLACK WALNUT
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-2507
Mailing Address - Country:US
Mailing Address - Phone:248-914-0520
Mailing Address - Fax:
Practice Address - Street 1:525 OAK CENTRE DR STE 450
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4072
Practice Address - Country:US
Practice Address - Phone:210-297-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1304838225100000X
2251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology