Healthcare Provider Details

I. General information

NPI: 1023530391
Provider Name (Legal Business Name): INDY MOBILE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2017
Last Update Date: 07/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4831 BRENTRIDGE PKWY
GREENWOOD IN
46143-9368
US

IV. Provider business mailing address

4831 BRENTRIDGE PKWY
GREENWOOD IN
46143-9368
US

V. Phone/Fax

Practice location:
  • Phone: 317-908-7307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GRANT WILLIAM FOLEY
Title or Position: OFFICER
Credential: PTA
Phone: 317-908-7307