Provider Demographics
NPI:1881490399
Name:MILES, TAVY LEE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:TAVY
Middle Name:LEE
Last Name:MILES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TAVY
Other - Middle Name:LEE
Other - Last Name:GALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2112
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:UT
Mailing Address - Zip Code:84713-2112
Mailing Address - Country:US
Mailing Address - Phone:435-310-0531
Mailing Address - Fax:
Practice Address - Street 1:1109 N 100 W
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:UT
Practice Address - Zip Code:84713-7746
Practice Address - Country:US
Practice Address - Phone:435-438-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14205096-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist