Healthcare Provider Details

I. General information

NPI: 1326686049
Provider Name (Legal Business Name): PRIORITY WELLNESS AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 W 86TH ST
INDIANAPOLIS IN
46260-2076
US

IV. Provider business mailing address

2070 W 106TH ST
CARMEL IN
46032-7918
US

V. Phone/Fax

Practice location:
  • Phone: 317-688-7560
  • Fax:
Mailing address:
  • Phone: 317-652-1584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: HARISHANTHAN S. NAGRIDDY
Title or Position: OWNER
Credential:
Phone: 317-652-1584