MEDICARE: SOUTHSIDE PHYSICAL THERAPY CLINIC

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	05001800A	IN

General Provider Information

NPI Number	:	1346205598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHSIDE PHYSICAL THERAPY CLINIC

Provider Business Mailing Address
First Line	:	8601 CREEKWOOD LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-9211
Country	:	US
Telephone Number	:	317-826-8866
Fax Number	:

Provider Business Practice Location Address
First Line	:	3440 S POST RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-8301
Country	:	US
Telephone Number	:	317-862-2860
Fax Number	:	317-862-0928

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ABOL DADFARMAY
Credential	:
Telephone Number	:	317-826-8866

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	08/22/2020

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