Provider Demographics
NPI:1992207773
Name:MILES, TOMMY KEVIN
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:KEVIN
Last Name:MILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 GAINES CREEK CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3326
Mailing Address - Country:US
Mailing Address - Phone:706-442-6567
Mailing Address - Fax:706-653-9469
Practice Address - Street 1:6911 GAINES CREEK CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3326
Practice Address - Country:US
Practice Address - Phone:706-442-6567
Practice Address - Fax:706-653-9469
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist