Provider Demographics
NPI:1336121227
Name:MILES, JOAL BERNARD (PT)
Entity Type:Individual
Prefix:MR
First Name:JOAL
Middle Name:BERNARD
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:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:CA
Mailing Address - Zip Code:96027-0717
Mailing Address - Country:US
Mailing Address - Phone:530-467-5800
Mailing Address - Fax:530-467-5808
Practice Address - Street 1:450 PIG ALLEY
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:CA
Practice Address - Zip Code:96027-9998
Practice Address - Country:US
Practice Address - Phone:530-467-5800
Practice Address - Fax:530-467-5808
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist