Provider Demographics
NPI:1558734566
Name:MILESTONES PEDIATRIC THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:MILESTONES PEDIATRIC THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANITA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:870-612-0654
Mailing Address - Street 1:907 S PINE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3805
Mailing Address - Country:US
Mailing Address - Phone:870-612-0654
Mailing Address - Fax:
Practice Address - Street 1:907 S PINE ST
Practice Address - Street 2:SUITE C
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3805
Practice Address - Country:US
Practice Address - Phone:870-612-0654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty