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General NPI Number Information
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NPI Number | 1194052290
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Entity Type | Organization
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Legal Business Name | MILESTONE THERAPY, LLC
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 6 SIEBENKITTEL CIR SUITE G
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City | CARRIERE
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State | MS
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Zip | 39426-8777
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Country | US
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Telephone | 601-799-4065
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Fax | 601-799-4064
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Provider Business Mailing Address
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Address Line | PO BOX 265
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City | TALLEVAST
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State | FL
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Zip | 34270-0265
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Country | US
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Telephone | 985-774-9082
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Fax | 601-799-4064
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Authorized Official
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Title or Position | PHYSICAL THERAPIST / OWNER
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Name | MRS. KAREN EASTBURN SURDI
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Credential | P,T.
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Telephone | 985-774-9082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT4582
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License Number State | MS
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