Healthcare Provider Details

I. General information

NPI: 1972545416
Provider Name (Legal Business Name): FUNCTION REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11688 LAKE FOREST PKWY
CARMEL IN
46033-7208
US

IV. Provider business mailing address

11688 LAKE FOREST PKWY
CARMEL IN
46033-7208
US

V. Phone/Fax

Practice location:
  • Phone: 317-818-8166
  • Fax: 317-818-8266
Mailing address:
  • Phone: 317-818-8166
  • Fax: 317-818-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. STEWART CLARK
Title or Position: PRESIDENT
Credential:
Phone: 317-818-8166