MEDICARE: MILESTONE THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05006226A	IN
2	235Z00000X	Speech-Language Pathologist	22004096A	IN
3	225100000X	Physical Therapist	70012822	IL
4	235Z00000X	Speech-Language Pathologist	146009098	IL
5	225XP0200X	Pediatric Occupational Therapist		IL
6	225XP0200X	Pediatric Occupational Therapist		IN
7	2251P0200X	Pediatric Physical Therapist		IL
8	2251P0200X	Pediatric Physical Therapist		IN
9	103K00000X	Behavior Analyst	17030805	IN
10	2251P0200X	Pediatric Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396814828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILESTONE THERAPY

Provider Business Mailing Address
First Line	:	2906 HIGHWAY AVE
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-1631
Country	:	US
Telephone Number	:	219-513-8311
Fax Number	:	708-479-2112

Provider Business Practice Location Address
First Line	:	2906 HIGHWAY AVE
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-1631
Country	:	US
Telephone Number	:	219-513-8311
Fax Number	:	708-479-2112

Authorized Official
Title or Position	:	MANAGER
Name	:	ANDREW T. HAVERSTOCK
Credential	:	PT
Telephone Number	:	219-229-0322

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	04/13/2017

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Directions to “MILESTONE THERAPY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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