Healthcare Provider Details

I. General information

NPI: 1124483078
Provider Name (Legal Business Name): MY REHAB AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2015
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 E VERMONT ST STE 110
INDIANAPOLIS IN
46202-3685
US

IV. Provider business mailing address

1205 DREW LN
YORKTOWN IN
47396-9815
US

V. Phone/Fax

Practice location:
  • Phone: 765-749-9871
  • Fax:
Mailing address:
  • Phone: 765-749-9871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: NAVIN AGARWAL
Title or Position: CO-OWNER
Credential: OTR
Phone: 765-749-9871