Provider Demographics
NPI:1780882902
Name:MILESTONES CHILD
Entity type:Organization
Organization Name:MILESTONES CHILD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LESIEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-260-3300
Mailing Address - Street 1:1490 E WHITESTONE BLVD
Mailing Address - Street 2:BUILDING 2, SUITE 100
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1490 E WHITESTONE BLVD
Practice Address - Street 2:BUILDING 2, SUITE 100
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2274
Practice Address - Country:US
Practice Address - Phone:512-260-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILESTONES CHILD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-10
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T7236OtherBCBSTX