Provider Demographics
NPI:1710940820
Name:KILES, MICHELLE P (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:P
Last Name:KILES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 MOUNTAIN VIEW AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-2096
Mailing Address - Country:US
Mailing Address - Phone:423-842-9322
Mailing Address - Fax:866-591-0619
Practice Address - Street 1:9292 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2380
Practice Address - Country:US
Practice Address - Phone:865-392-1033
Practice Address - Fax:866-591-0619
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3645785Medicaid
TN4110126OtherBLUE CROSS BLUE SHIELD
3645785Medicare ID - Type Unspecified