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General NPI Number Information
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NPI Number | 1124195540
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Entity Type | Organization
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Legal Business Name | MILAGRO THERAPY SERVICES LLC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 2601 CHERRY AVE STE 211
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City | BREMERTON
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State | WA
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Zip | 98310-4208
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Country | US
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Telephone | 564-333-4267
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Fax | 360-218-7967
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Provider Business Mailing Address
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Address Line | 2601 CHERRY AVE STE 211
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City | BREMERTON
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State | WA
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Zip | 98310-4208
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Country | US
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Telephone | 564-333-4267
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Fax | 360-218-7967
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Authorized Official
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Title or Position | OWNER
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Name | MS. CYNTHIA BONILLA
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Credential | OT
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Telephone | 564-333-4267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3205
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2133
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2181
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License Number State | NM
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