Provider Demographics
NPI:1215487376
Name:MILEMARKERS THERAPY
Entity type:Organization
Organization Name:MILEMARKERS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCSHEA
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:928-854-5439
Mailing Address - Street 1:5601 HIGHWAY 95 N STE 308C
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86404-8546
Mailing Address - Country:US
Mailing Address - Phone:928-854-5439
Mailing Address - Fax:928-854-5440
Practice Address - Street 1:5601 HIGHWAY 95 N STE 308C5601
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86404-8536
Practice Address - Country:US
Practice Address - Phone:928-854-5439
Practice Address - Fax:928-854-5440
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILEMARKERS THERAPY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-12
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
AZSLP4317235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ819797Medicaid