Basic Information
| Provider Information | |||||||||
| NPI: | 1457316010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILES-RODRIGUEZ | ||||||||
| FirstName: | VICKI | ||||||||
| MiddleName: | |||||||||
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| Credential: | L.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1714 BOCA CHICA BLVD | ||||||||
| Address2: | |||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785208141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9565442401 | ||||||||
| FaxNumber: | 9565042234 | ||||||||
| Practice Location | |||||||||
| Address1: | 1714 BOCA CHICA BLVD | ||||||||
| Address2: | |||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785208141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9565442401 | ||||||||
| FaxNumber: | 9565042234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 07/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1048759 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0877110-01 | 05 | TX | MEDICAID |