Healthcare Provider Details

I. General information

NPI: 1124667449
Provider Name (Legal Business Name): CORE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11055 BROADWAY STE A
CROWN POINT IN
46307-7300
US

IV. Provider business mailing address

11055 BROADWAY STE A
CROWN POINT IN
46307-7300
US

V. Phone/Fax

Practice location:
  • Phone: 219-797-7463
  • Fax:
Mailing address:
  • Phone: 219-797-7463
  • Fax: 219-323-3346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ZESHAN HYDER
Title or Position: OWNER
Credential: DO
Phone: 219-797-7463