Healthcare Provider Details

I. General information

NPI: 1669011060
Provider Name (Legal Business Name): MILESTONES THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 N PEBBLE CREEK PKWY APT 2072
GOODYEAR AZ
85395-9029
US

IV. Provider business mailing address

4200 N PEBBLE CREEK PKWY APT 2072
GOODYEAR AZ
85395-9029
US

V. Phone/Fax

Practice location:
  • Phone: 815-603-8637
  • Fax:
Mailing address:
  • Phone: 815-603-8637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: CRAIG MARTIN
Title or Position: CFO
Credential:
Phone: 815-603-8637