Provider Demographics
NPI:1104503481
Name:MILESTONE MASTERS PEDIATRIC THERAPY INC
Entity type:Organization
Organization Name:MILESTONE MASTERS PEDIATRIC THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, CCC-SLP
Authorized Official - Phone:703-509-6109
Mailing Address - Street 1:3543 EWELL ST
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1708
Mailing Address - Country:US
Mailing Address - Phone:703-509-6109
Mailing Address - Fax:
Practice Address - Street 1:3543 EWELL ST
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1708
Practice Address - Country:US
Practice Address - Phone:703-509-6109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty