Provider Demographics
NPI:1740282029
Name:SYKES, MILES (DPT, MPT, OTR)
Entity type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:SYKES
Suffix:
Gender:M
Credentials:DPT, MPT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 CALDER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1845
Mailing Address - Country:US
Mailing Address - Phone:409-813-1920
Mailing Address - Fax:409-813-1486
Practice Address - Street 1:3570 COLLEGE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4683
Practice Address - Country:US
Practice Address - Phone:409-813-1920
Practice Address - Fax:409-813-1486
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105903225X00000X
TX1112530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168798001Medicaid
TX8S4279OtherBCBS TEXAS
TX8B8389Medicare PIN
TX8S4279OtherBCBS TEXAS
TXP00218630Medicare PIN