MEDICARE: KAREN LOUNSBURY 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	05001618A	IN

General Provider Information

NPI Number	:	1528172061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LOUNSBURY PT

Provider Business Mailing Address
First Line	:	8259 WICKER AVE
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-8878
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 WATLING ST
Second Line	:	8-210
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-1716
Country	:	US
Telephone Number	:	219-399-6668
Fax Number	:

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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