Healthcare Provider Details

I. General information

NPI: 1922985969
Provider Name (Legal Business Name): CHARLOTTE RENEE WEST PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W CARLOS FOLGER DR
COLUMBUS IN
47201-1334
US

IV. Provider business mailing address

220 N POPLAR ST
BROWNSTOWN IN
47220-1416
US

V. Phone/Fax

Practice location:
  • Phone: 812-348-2141
  • Fax:
Mailing address:
  • Phone: 812-530-6966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06006656A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: