MEDICARE: MILESTONES CHILDREN'S THERAPY CENTER, 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	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467989475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILESTONES CHILDREN'S THERAPY CENTER, LLC

Provider Business Mailing Address
First Line	:	111 E LAKE MARY BLVD STE 113
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32773-7111
Country	:	US
Telephone Number	:	407-203-9492
Fax Number	:	321-332-9768

Provider Business Practice Location Address
First Line	:	111 E LAKE MARY BLVD STE 113
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32773-7111
Country	:	US
Telephone Number	:	407-203-9492
Fax Number	:	321-332-9768

Authorized Official
Title or Position	:	MANAGER
Name	:	VIVIANA RAZURI
Credential	:	BS/SLPA
Telephone Number	:	407-203-9492

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	05/25/2023

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