Healthcare Provider Details

I. General information

NPI: 1962987255
Provider Name (Legal Business Name): PTWORX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5006 S ROGERS ST
BLOOMINGTON IN
47403-4655
US

IV. Provider business mailing address

3509 S GLASGOW CIR
BLOOMINGTON IN
47403-7900
US

V. Phone/Fax

Practice location:
  • Phone: 812-361-6989
  • Fax:
Mailing address:
  • Phone: 917-361-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. CHRISTIAN VILLANUEVA SALVA
Title or Position: OWNER
Credential:
Phone: 812-269-2679