Provider Demographics
NPI:1316367188
Name:MILES, BRYN (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRYN
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BILTMORE PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-9344
Mailing Address - Country:US
Mailing Address - Phone:386-937-9833
Mailing Address - Fax:
Practice Address - Street 1:4875 PALM COAST PKWY NW
Practice Address - Street 2:SUITE 2 & 3
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3670
Practice Address - Country:US
Practice Address - Phone:386-793-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12287235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist