Healthcare Provider Details

I. General information

NPI: 1558734566
Provider Name (Legal Business Name): MILESTONES PEDIATRIC THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 10/10/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S. 2ND ST. SUITE B
CABOT AR
72023
US

IV. Provider business mailing address

2800 S. 2ND ST. SUITE B
CABOT AR
72023
US

V. Phone/Fax

Practice location:
  • Phone: 501-286-6075
  • Fax: 501-286-6175
Mailing address:
  • Phone: 501-286-6075
  • Fax: 501-286-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LANITA K RUSSELL
Title or Position: CO-OWNER
Credential: PT, DPT
Phone: 870-612-0654