Provider Demographics
NPI:1720104268
Name:MILES, LADANA (PT)
Entity Type:Individual
Prefix:
First Name:LADANA
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6490 N OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2245
Mailing Address - Country:US
Mailing Address - Phone:317-259-7523
Mailing Address - Fax:317-259-7524
Practice Address - Street 1:6490 N OXFORD ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2245
Practice Address - Country:US
Practice Address - Phone:317-259-7523
Practice Address - Fax:317-259-7524
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004137A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist