Provider Demographics
NPI:1962661314
Name:MILES, ALEXIA R (PT)
Entity Type:Individual
Prefix:MS
First Name:ALEXIA
Middle Name:R
Last Name:MILES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ALEXIA
Other - Middle Name:R
Other - Last Name:SHATTUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10000 W INNOVATION DR
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4837
Mailing Address - Country:US
Mailing Address - Phone:414-456-5006
Mailing Address - Fax:414-456-6259
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist