Provider Demographics
NPI:1023243177
Name:MILESTONE PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:MILESTONE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEELY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KOWALCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:425-455-0699
Mailing Address - Street 1:4205 148TH AVE NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-7114
Mailing Address - Country:US
Mailing Address - Phone:425-455-0699
Mailing Address - Fax:425-455-1541
Practice Address - Street 1:4205 148TH AVE NE
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-7114
Practice Address - Country:US
Practice Address - Phone:425-455-0699
Practice Address - Fax:425-455-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty