MEDICARE: MISS DALJEET KAUR TREHAN 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	05006448A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200602650	OTHER	IN	WEB INTERCHANGE
2	200702350A	OTHER	IN	WEB INTERCHANGE

General Provider Information

NPI Number	:	1639247117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DALJEET KAUR TREHAN PT

Provider Business Mailing Address
First Line	:	5039 PIKE CREEK BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5757
Country	:	US
Telephone Number	:	317-270-8836
Fax Number	:

Provider Business Practice Location Address
First Line	:	5039 PIKE CREEK BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5757
Country	:	US
Telephone Number	:	317-270-8836
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	10/18/2016

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