MEDICARE: MICHAEL KERRIGAN

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05007625A	OTHER	IN	LICENSE#

General Provider Information

NPI Number	:	1902976624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL KERRIGAN

Provider Business Mailing Address
First Line	:	17042 FINCHUM WAY WEST
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060
Country	:	US
Telephone Number	:	317-770-1984
Fax Number	:

Provider Business Practice Location Address
First Line	:	9011 N MERIDIAN ST STE 112
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2399
Country	:	US
Telephone Number	:	317-571-0017
Fax Number	:

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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