Organization
MILESTONE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW T. HAVERSTOCK PT (MANAGER)
(219) 229-0322
Entity
Organization
Contact information
Practice address
2906 HIGHWAY AVE, HIGHLAND, IN 46322-1631
(219) 513-8311
(708) 479-2112
Mailing address
2906 HIGHWAY AVE, HIGHLAND, IN 46322-1631
(219) 513-8311
(708) 479-2112
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
17030805
IN
225100000X
Physical Therapist
05006226A
IN
225100000X
Physical Therapist
70012822
IL
2251P0200X
Pediatric Physical Therapist
—
IL
2251P0200X
Pediatric Physical Therapist
—
IN
2251P0200X
Pediatric Physical Therapist
Primary
—
—
225XP0200X
Pediatric Occupational Therapist
—
IL
225XP0200X
Pediatric Occupational Therapist
—
IN
235Z00000X
Speech-Language Pathologist
146009098
IL
235Z00000X
Speech-Language Pathologist
22004096A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201283100A
—
IN
Enumeration date
11/07/2006
Last updated
04/13/2017
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