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NPI Code Detail

MEDICARE: REQUEST PHYSICAL THERAPY, INC.

MEDICARE: REQUEST PHYSICAL THERAPY, INC.
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
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000222166OTHERINANTHEM

General Provider Information

NPI Number : 1164471637
Entity Type Code : Organization
Provider Name (Legal Business Name) : REQUEST PHYSICAL THERAPY, INC.
Provider Business Mailing Address
First Line : 4018 COLUMBUS AVE
Second Line :
City : ANDERSON
State : IN
Zip : 46013-5010
Country : US
Telephone Number : 765-649-5564
Fax Number : 765-641-7607
Provider Business Practice Location Address
First Line : 4018 COLUMBUS AVE
Second Line :
City : ANDERSON
State : IN
Zip : 46013-5010
Country : US
Telephone Number : 765-649-5564
Fax Number : 765-641-7607
Authorized Official
Title or Position : CEO
Name : RANDY COOK
Credential :
Telephone Number : 765-649-5564
Provider Enumeration Date : 05/10/2006
Last Update Date : 12/05/2007

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Directions to “REQUEST PHYSICAL THERAPY, INC. ” Practice Location

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