Provider Demographics
NPI:1912101411
Name:MILES, VICKI JANE (PT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:JANE
Last Name:MILES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:JANE
Other - Last Name:PYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110904 VON HERTZEN CIR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2708
Mailing Address - Country:US
Mailing Address - Phone:952-448-5949
Mailing Address - Fax:952-403-3979
Practice Address - Street 1:1661 PARK RIDGE DR
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2841
Practice Address - Country:US
Practice Address - Phone:952-403-3981
Practice Address - Fax:952-403-3979
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist