MEDICARE: MR. ANDREAS LOHMAR PT

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	225100000X	Physical Therapist	5002908	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5002908	OTHER	IN	STATE LICENSE

General Provider Information

NPI Number	:	1124245949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREAS LOHMAR PT

Provider Business Mailing Address
First Line	:	5310 MERCHANDISE DRIVE
Second Line	:
City	:	FT. WAYNE
State	:	IN
Zip	:	46825
Country	:	US
Telephone Number	:	260-484-9491
Fax Number	:	260-484-9451

Provider Business Practice Location Address
First Line	:	5310 MERCHANDISE DRIVE
Second Line	:
City	:	FT. WAYNE
State	:	IN
Zip	:	46825
Country	:	US
Telephone Number	:	260-484-9491
Fax Number	:	260-484-9451

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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