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General NPI Number Information
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NPI Number | 1386038123
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Entity Type | Organization
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Legal Business Name | MILESTONE PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 5814 LONETREE BLVD SUITE 100
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City | ROCKLIN
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State | CA
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Zip | 95765-3785
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Country | US
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Telephone | 916-206-3612
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Fax | 916-596-4062
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Provider Business Mailing Address
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Address Line | 5814 LONETREE BLVD SUITE 100
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City | ROCKLIN
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State | CA
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Zip | 95765-3785
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Country | US
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Telephone | 916-206-3612
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Fax | 916-596-4062
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/ OWNER
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Name | MRS. MOLLIE ELIZABETH TANJOCO
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Credential | M.P.T.
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Telephone | 916-206-3612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 30218
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License Number State | CA
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