Provider Demographics
NPI:1528184116
Name:MILES, JEAN A (PA-C, PT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:MILES
Suffix:
Gender:F
Credentials:PA-C, PT
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 LANSING ST
Mailing Address - Street 2:AMMS, PC CREDENTIALING OFFICE
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-255-7438
Mailing Address - Fax:315-255-7099
Practice Address - Street 1:17 E GENESEE ST
Practice Address - Street 2:SUITE #101
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4040
Practice Address - Country:US
Practice Address - Phone:315-253-5151
Practice Address - Fax:315-253-0841
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY13066225100000X
NY013624363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02399411Medicaid
NYJ400029054Medicare PIN