Provider Demographics
NPI:1275190563
Name:MILESTONES & STAGES PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:MILESTONES & STAGES PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LONA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:DT
Authorized Official - Phone:870-336-2778
Mailing Address - Street 1:115 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72417-8839
Mailing Address - Country:US
Mailing Address - Phone:870-336-2778
Mailing Address - Fax:870-336-2558
Practice Address - Street 1:115 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BROOKLAND
Practice Address - State:AR
Practice Address - Zip Code:72417-8839
Practice Address - Country:US
Practice Address - Phone:870-336-2778
Practice Address - Fax:870-336-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty