Provider Demographics
NPI:1003002619
Name:MILES, DANIELLE N (PTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:N
Last Name:MILES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX V
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-0047
Mailing Address - Country:US
Mailing Address - Phone:770-228-2721
Mailing Address - Fax:
Practice Address - Street 1:670 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4214
Practice Address - Country:US
Practice Address - Phone:770-229-6498
Practice Address - Fax:770-229-6958
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002375225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant