Healthcare Provider Details

I. General information

NPI: 1609174788
Provider Name (Legal Business Name): CAMBY PHYSICAL MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 S KENTUCKY AVE STE 109
CAMBY IN
46113-0000
US

IV. Provider business mailing address

1420 SADLIER CIRCLE E DRIVE
INDIANAPOLIS IN
46239-0000
US

V. Phone/Fax

Practice location:
  • Phone: 317-683-1970
  • Fax: 317-683-1989
Mailing address:
  • Phone: 317-856-4800
  • Fax: 317-856-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRY J TOLLE
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 317-683-1970