MEDICARE: MASTERING MILESTONES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1356974067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASTERING MILESTONES, LLC

Provider Business Mailing Address
First Line	:	1564 RED TIDE RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-9406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1564 RED TIDE RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-9406
Country	:	US
Telephone Number	:	610-570-7321
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	ERIKA SHUMOCK
Credential	:	PT, DPT
Telephone Number	:	610-570-7321

Provider Enumeration Date	:	02/20/2020
Last Update Date	:	06/05/2020

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