Healthcare Provider Details

I. General information

NPI: 1366748436
Provider Name (Legal Business Name): HEALTH 1ST PHYSICAL REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6326 RUCKER RD SUITE F
INDIANAPOLIS IN
46220-4889
US

IV. Provider business mailing address

6326 RUCKER RD SUITE F
INDIANAPOLIS IN
46220-4889
US

V. Phone/Fax

Practice location:
  • Phone: 317-253-1644
  • Fax: 317-253-9708
Mailing address:
  • Phone: 317-253-1644
  • Fax: 317-253-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number08001746A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05010034A
License Number StateIN

VIII. Authorized Official

Name: DR. DAVID J DUNHAM
Title or Position: OWNER
Credential: DPT, DC
Phone: 317-253-1644