Provider Demographics
NPI:1568513166
Name:CHILDREN'S MILESTONE INC
Entity Type:Organization
Organization Name:CHILDREN'S MILESTONE INC
Other - Org Name:DUPONT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUENCONSEJO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:260-497-0838
Mailing Address - Street 1:2872 E DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1669
Mailing Address - Country:US
Mailing Address - Phone:260-497-0838
Mailing Address - Fax:260-497-9088
Practice Address - Street 1:2872 E DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1669
Practice Address - Country:US
Practice Address - Phone:260-497-0838
Practice Address - Fax:260-497-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-03-05
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN179110Medicare PIN
IN179100Medicare PIN