MEDICARE: COURTNEY HERTEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	06003496A	IN

General Provider Information

NPI Number	:	1053733444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY HERTEL

Provider Business Mailing Address
First Line	:	1500 N RITTER AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-3027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 N SHADELAND AVE STE 100
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1712
Country	:	US
Telephone Number	:	317-355-5905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2014
Last Update Date	:	01/20/2014

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Directions to “ COURTNEY HERTEL ” Practice Location

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