Healthcare Provider Details

I. General information

NPI: 1902588783
Provider Name (Legal Business Name): MERISSA STANDRIDGE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3192 E 400 S
GREENFIELD IN
46140-9257
US

IV. Provider business mailing address

3192 E 400 S
GREENFIELD IN
46140-9257
US

V. Phone/Fax

Practice location:
  • Phone: 765-994-6445
  • Fax:
Mailing address:
  • Phone: 765-994-6445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number05015429A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: