Healthcare Provider Details

I. General information

NPI: 1356386668
Provider Name (Legal Business Name): BRIAN JEROME PEASE P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 N MERIDIAN ST STE 215
INDIANAPOLIS IN
46260-5382
US

IV. Provider business mailing address

8902 N MERIDIAN ST STE 215
INDIANAPOLIS IN
46260-5382
US

V. Phone/Fax

Practice location:
  • Phone: 317-581-1890
  • Fax: 317-581-2436
Mailing address:
  • Phone: 317-581-1890
  • Fax: 317-581-2436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05002149A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: