MEDICARE: MILESTONES THERAPY AND WELLNESS, LLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1417730573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILESTONES THERAPY AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	140 SAVANNAH LN
Second Line	:
City	:	ROCKY TOP
State	:	TN
Zip	:	37769-5207
Country	:	US
Telephone Number	:	423-494-4302
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 SAVANNAH LN
Second Line	:
City	:	ROCKY TOP
State	:	TN
Zip	:	37769-5207
Country	:	US
Telephone Number	:	423-494-4302
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHEYENNE KATHLEEN ALLEN
Credential	:	PT, DPT
Telephone Number	:	865-210-8268

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	08/14/2023

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