MEDICARE: AMY DAWN MEDLEY

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	05010824A	IN

General Provider Information

NPI Number	:	1568717106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY DAWN MEDLEY

Provider Business Mailing Address
First Line	:	985 DORMAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3570
Country	:	US
Telephone Number	:	317-288-1763
Fax Number	:	816-208-9047

Provider Business Practice Location Address
First Line	:	985 DORMAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3570
Country	:	US
Telephone Number	:	317-288-1763
Fax Number	:	816-208-9047

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

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	01/29/2024

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Directions to “ AMY DAWN MEDLEY ” Practice Location

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