Healthcare Provider Details

I. General information

NPI: 1912358003
Provider Name (Legal Business Name): HELEN HATFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N BEND RD
BEECH GROVE IN
46107-2519
US

IV. Provider business mailing address

502 N BEND RD
BEECH GROVE IN
46107-2519
US

V. Phone/Fax

Practice location:
  • Phone: 812-592-1347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06005197A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: