Healthcare Provider Details

I. General information

NPI: 1295772689
Provider Name (Legal Business Name): CHILDREN'S THERAPY PLUS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6504 E 129TH AVE
CROWN POINT IN
46307-9087
US

IV. Provider business mailing address

6504 E 129TH AVE
CROWN POINT IN
46307-9087
US

V. Phone/Fax

Practice location:
  • Phone: 219-662-7654
  • Fax: 219-662-2136
Mailing address:
  • Phone: 219-662-7654
  • Fax: 219-662-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. ANTHONY MITCHELL CLARK
Title or Position: OWNER
Credential:
Phone: 219-662-7654