Provider Demographics
NPI:1831357193
Name:MILESTONES THERAPY & WELLNESS GROUP, LLC
Entity type:Organization
Organization Name:MILESTONES THERAPY & WELLNESS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LADANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:317-259-7523
Mailing Address - Street 1:6490 N OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2245
Mailing Address - Country:US
Mailing Address - Phone:317-259-7523
Mailing Address - Fax:317-259-7524
Practice Address - Street 1:6490 N OXFORD ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2245
Practice Address - Country:US
Practice Address - Phone:317-259-7523
Practice Address - Fax:317-259-7524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004137A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200629960Medicaid
IN200730140Medicaid