Provider Demographics
NPI:1932742277
Name:MILES, SETH (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:MILES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 CRILL AVE BLDG 3
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-9231
Mailing Address - Country:US
Mailing Address - Phone:386-433-6088
Mailing Address - Fax:
Practice Address - Street 1:6500 CRILL AVE BLDG 3
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-9231
Practice Address - Country:US
Practice Address - Phone:386-433-6088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist