Healthcare Provider Details

I. General information

NPI: 1447654447
Provider Name (Legal Business Name): WALK AND TALK PHYSICAL AND SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 N MAIN ST
CROWN POINT IN
46307-2002
US

IV. Provider business mailing address

1100 CHURCHILL LN
CROWN POINT IN
46307-5068
US

V. Phone/Fax

Practice location:
  • Phone: 219-730-1153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05004131A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22004212A
License Number StateIN

VIII. Authorized Official

Name: BARBARA VANDERWOUDE
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 219-730-1153