Provider Demographics
NPI:1841527850
Name:MILES, ELEANOR (LMT)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1331
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32175-1331
Mailing Address - Country:US
Mailing Address - Phone:386-451-3602
Mailing Address - Fax:
Practice Address - Street 1:555 W GRANADA BLVD STE D6
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5196
Practice Address - Country:US
Practice Address - Phone:386-615-8195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA022833174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist