Healthcare Provider Details

I. General information

NPI: 1992101638
Provider Name (Legal Business Name): INDIANA PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10021 DUPONT CIRCLE COURT
FORT WAYNE IN
46825
US

IV. Provider business mailing address

4251 LAHMEYER RD.
FORT WAYNE IN
46815
US

V. Phone/Fax

Practice location:
  • Phone: 260-207-1637
  • Fax: 260-459-9262
Mailing address:
  • Phone: 260-432-4700
  • Fax: 260-459-9262

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: DRU NICHOLE BISHOP
Title or Position: CREDENTIALING SPEC.
Credential:
Phone: 260-432-4700