Healthcare Provider Details

I. General information

NPI: 1790614717
Provider Name (Legal Business Name): TERRAN THROUGH MILESTONES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6234 ROSE LAKE AVE
SAN DIEGO CA
92119-3343
US

IV. Provider business mailing address

6234 ROSE LAKE AVE
SAN DIEGO CA
92119-3343
US

V. Phone/Fax

Practice location:
  • Phone: 619-333-0780
  • Fax:
Mailing address:
  • Phone: 619-333-0780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TERRAN TRAVIS
Title or Position: OWNER / FOUNDER
Credential: PT, DPT
Phone: 509-539-7458