Healthcare Provider Details

I. General information

NPI: 1750564274
Provider Name (Legal Business Name): IMA, INC. PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 S ROGERS ST
BLOOMINGTON IN
47403-2335
US

IV. Provider business mailing address

719 S ROGERS ST
BLOOMINGTON IN
47403-2335
US

V. Phone/Fax

Practice location:
  • Phone: 812-323-4475
  • Fax: 812-323-4478
Mailing address:
  • Phone: 812-323-4475
  • Fax: 812-323-4478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberNA
License Number StateIN

VIII. Authorized Official

Name: DR. WESLEY W RATLIFF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 812-331-3400