Provider Demographics
NPI:1396476602
Name:MILES, DYLAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:DYLAN
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 1:14287 N 87TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3698
Mailing Address - Country:US
Mailing Address - Phone:480-551-4966
Mailing Address - Fax:
Practice Address - Street 1:6824 E BROWN RD STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3703
Practice Address - Country:US
Practice Address - Phone:480-924-5514
Practice Address - Fax:480-924-5518
Is Sole Proprietor?:No
Enumeration Date:2022-06-19
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32380225100000X
AZLPT-32380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist