Healthcare Provider Details

I. General information

NPI: 1962720532
Provider Name (Legal Business Name): MILESTONES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 COTTONWOOD PASS RD
GYPSUM CO
81637-9709
US

IV. Provider business mailing address

260 COTTONWOOD PASS RD
GYPSUM CO
81637-9709
US

V. Phone/Fax

Practice location:
  • Phone: 970-331-2632
  • Fax: 970-328-4472
Mailing address:
  • Phone: 970-331-2632
  • Fax: 970-328-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number6546
License Number StateCO

VIII. Authorized Official

Name: MS. TAMMY A RODELL
Title or Position: MANAGER
Credential: PT
Phone: 970-331-2632