Healthcare Provider Details

I. General information

NPI: 1194052290
Provider Name (Legal Business Name): MILESTONE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SIEBENKITTEL CIR SUITE G
CARRIERE MS
39426-8777
US

IV. Provider business mailing address

PO BOX 265
TALLEVAST FL
34270-0265
US

V. Phone/Fax

Practice location:
  • Phone: 601-799-4065
  • Fax: 601-799-4064
Mailing address:
  • Phone: 985-774-9082
  • Fax: 601-799-4064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT4582
License Number StateMS

VIII. Authorized Official

Name: MRS. KAREN EASTBURN SURDI
Title or Position: PHYSICAL THERAPIST / OWNER
Credential: P,T.
Phone: 985-774-9082