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Organization
MILESTONE PEDIATRIC THERAPY, PC.
Active
Organization
MILESTONE PEDIATRIC THERAPY, PC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COREY SUMMERLIN ROAN OTR/L (OWNER)
(757) 288-9512
Entity
Organization
Contact information
Practice address
5057 FRINK AVE, SAN DIEGO, CA 92117-1212
(757) 288-9512
Mailing address
5057 FRINK AVE, SAN DIEGO, CA 92117-1212
(757) 288-9512
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12913
OCCUPATIONAL THERAPIST
CA
Enumeration date
08/25/2017
Last updated
07/21/2022
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