1871626077 NPI number — MILESTONES CHILDREN'S THERAPY

Table of content: (NPI 1871626077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871626077 NPI number — MILESTONES CHILDREN'S THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILESTONES CHILDREN'S THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871626077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1490 E WHITESTONE BLVD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
CEDAR PARK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78613-2274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-260-3300
Provider Business Mailing Address Fax Number:
512-260-3343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1490 E WHITESTONE BLVD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
CEDAR PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78613-2274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-260-3300
Provider Business Practice Location Address Fax Number:
512-260-3343
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LESIEUR
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
SPEECH-LANGUAGE PATHOLOGIST-OWNER
Authorized Official Telephone Number:
512-260-3300

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 18312-1 . This is a "PACIFICARE PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 007OHV . This is a "BCBS PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7937419 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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