Provider Demographics
NPI:1457316010
Name:MILES-RODRIGUEZ, VICKI (LPT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:MILES-RODRIGUEZ
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 BOCA CHICA BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8141
Mailing Address - Country:US
Mailing Address - Phone:956-544-2401
Mailing Address - Fax:956-504-2234
Practice Address - Street 1:1714 BOCA CHICA BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8141
Practice Address - Country:US
Practice Address - Phone:956-544-2401
Practice Address - Fax:956-504-2234
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0877110-01Medicaid
TXTXB101315Medicare PIN
TXR59412Medicare UPIN
TXTXB101316Medicare PIN
TX0877110-01Medicaid