Healthcare Provider Details

I. General information

NPI: 1457551541
Provider Name (Legal Business Name): CAROL MARIE URBANSKI P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14530 JOHN PAUL WAY
CARMEL IN
46032-1211
US

IV. Provider business mailing address

14530 JOHN PAUL WAY
CARMEL IN
46032-1211
US

V. Phone/Fax

Practice location:
  • Phone: 317-627-2013
  • Fax: 317-569-1970
Mailing address:
  • Phone: 317-627-2013
  • Fax: 317-569-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05001895A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: