Healthcare Provider Details

I. General information

NPI: 1285121814
Provider Name (Legal Business Name): ERIN E OVERWAY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN E ANGLE DPT

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 S COLLEGE MALL RD STE A
BLOOMINGTON IN
47401
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 812-558-3356
  • Fax: 812-558-3377
Mailing address:
  • Phone: 803-812-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05012991A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: