1376727545 NPI number — MILESTONES PEDIATRIC THERAPY, LLC

Table of content: (NPI 1376727545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376727545 NPI number — MILESTONES PEDIATRIC THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
MILESTONES PEDIATRIC THERAPY, LLC
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:
1376727545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 SKOKIE BLVD
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
NORTHBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60062-2857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-711-2043
Provider Business Mailing Address Fax Number:
847-787-5323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 SKOKIE BLVD
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
NORTHBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60062-2857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-711-2043
Provider Business Practice Location Address Fax Number:
847-787-5323
Provider Enumeration Date:
12/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
888-711-2043

Provider Taxonomy Codes

  • Taxonomy code: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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