Healthcare Provider Details

I. General information

NPI: 1295884682
Provider Name (Legal Business Name): MARIE JEAN MERCADO HEDGES PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 16TH ST.
HOBART IN
46342
US

IV. Provider business mailing address

P.O BOX 14125
MERRILLVILLE IN
46410
US

V. Phone/Fax

Practice location:
  • Phone: 219-947-8152
  • Fax: 219-942-7641
Mailing address:
  • Phone: 219-947-8152
  • Fax: 219-942-7641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05003851A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: