Provider Demographics
NPI:1982221016
Name:MILESTONES & MOVEMENT PEDIATRIC PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MILESTONES & MOVEMENT PEDIATRIC PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, PCS
Authorized Official - Phone:516-528-5120
Mailing Address - Street 1:206 CALM WATER WAY
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-6902
Mailing Address - Country:US
Mailing Address - Phone:516-528-5120
Mailing Address - Fax:
Practice Address - Street 1:206 CALM WATER WAY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-6902
Practice Address - Country:US
Practice Address - Phone:516-528-5120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty