Provider Demographics
NPI:1437548039
Name:MILESTONES PEDIATRIC THERAPY INC.
Entity Type:Organization
Organization Name:MILESTONES PEDIATRIC THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:ELISSA
Authorized Official - Last Name:TARR
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:815-712-8915
Mailing Address - Street 1:802 KNOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4224
Mailing Address - Country:US
Mailing Address - Phone:715-712-8915
Mailing Address - Fax:815-324-9107
Practice Address - Street 1:802 KNOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-4224
Practice Address - Country:US
Practice Address - Phone:715-712-8915
Practice Address - Fax:815-324-9107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016644252Y00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No252Y00000XAgenciesEarly Intervention Provider Agency