Provider Demographics
NPI:1194052290
Name:MILESTONE THERAPY, LLC
Entity type:Organization
Organization Name:MILESTONE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:EASTBURN
Authorized Official - Last Name:SURDI
Authorized Official - Suffix:
Authorized Official - Credentials:P,T
Authorized Official - Phone:985-774-9082
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:TALLEVAST
Mailing Address - State:FL
Mailing Address - Zip Code:34270-0265
Mailing Address - Country:US
Mailing Address - Phone:985-774-9082
Mailing Address - Fax:601-799-4064
Practice Address - Street 1:6 SIEBENKITTEL CIR
Practice Address - Street 2:SUITE G
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-8777
Practice Address - Country:US
Practice Address - Phone:601-799-4065
Practice Address - Fax:601-799-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT45822251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04037825Medicaid