Provider Demographics
NPI:1912945247
Name:MILES, ANDY NOEL (PT)
Entity Type:Individual
Prefix:MR
First Name:ANDY
Middle Name:NOEL
Last Name:MILES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W MAGNOLIA AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7654
Mailing Address - Country:US
Mailing Address - Phone:817-335-7946
Mailing Address - Fax:817-335-7947
Practice Address - Street 1:160 W MAGNOLIA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7654
Practice Address - Country:US
Practice Address - Phone:817-335-7946
Practice Address - Fax:817-335-7947
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1146991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX805479Medicare ID - Type UnspecifiedID NUMBER