MEDICARE: MINI MILESTONES, 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	225100000X	Physical Therapist	05006221A	IN

General Provider Information

NPI Number	:	1508089590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINI MILESTONES, LLC

Provider Business Mailing Address
First Line	:	8506 PRESERVATION WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-9598
Country	:	US
Telephone Number	:	317-847-8217
Fax Number	:	317-328-1248

Provider Business Practice Location Address
First Line	:	8506 PRESERVATION WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-9598
Country	:	US
Telephone Number	:	317-847-8217
Fax Number	:	317-328-1248

Authorized Official
Title or Position	:	MEMBER-MANAGER
Name	:	RENEE RIESER
Credential	:	P.T., M.S., P.C.S.
Telephone Number	:	317-847-8217

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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Directions to “MINI MILESTONES, LLC ” Practice Location

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