MEDICARE: DUPONT 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 State
1	225X00000X	Occupational Therapist	IN
2	235Z00000X	Speech-Language Pathologist	IN
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1588991939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUPONT PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	10351 DAWSONS CREEK BLVD
Second Line	:	SUITE H
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1904
Country	:	US
Telephone Number	:	260-489-9533
Fax Number	:	260-497-9088

Provider Business Practice Location Address
First Line	:	10351 DAWSONS CREEK BLVD
Second Line	:	SUITE H
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1904
Country	:	US
Telephone Number	:	260-489-9533
Fax Number	:	260-497-9088

Authorized Official
Title or Position	:	DIRECTOR/MANAGER
Name	:	ABBY BUENCONSEJO
Credential	:	OTR
Telephone Number	:	260-489-9533

Provider Enumeration Date	:	11/05/2009
Last Update Date	:	01/17/2013

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Directions to “DUPONT PHYSICAL THERAPY INC ” Practice Location

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