Provider Demographics
NPI:1073222899
Name:MILES, KEESHIA (PT)
Entity Type:Individual
Prefix:
First Name:KEESHIA
Middle Name:
Last Name:MILES
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 1:14017 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5586
Mailing Address - Country:US
Mailing Address - Phone:405-478-5333
Mailing Address - Fax:405-478-5334
Practice Address - Street 1:14017 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5586
Practice Address - Country:US
Practice Address - Phone:405-478-5333
Practice Address - Fax:405-478-5334
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200250850AMedicaid