Healthcare Provider Details

I. General information

NPI: 1184246621
Provider Name (Legal Business Name): ACHIEVING MILESTONES PEDIATRIC THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E GLENOAKS BLVD # 225A
GLENDALE CA
91207-2085
US

IV. Provider business mailing address

1018 ELM AVE
GLENDALE CA
91201-3424
US

V. Phone/Fax

Practice location:
  • Phone: 818-288-3334
  • Fax:
Mailing address:
  • Phone: 818-288-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. EDIT KATHY KESHISHYAN
Title or Position: CEO
Credential: OT
Phone: 818-288-3334