Healthcare Provider Details

I. General information

NPI: 1679481295
Provider Name (Legal Business Name): LUCY HAAB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCY MARTIN

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 W EDGEWOOD AVE
INDIANAPOLIS IN
46217-9291
US

IV. Provider business mailing address

1502 W EDGEWOOD AVE
INDIANAPOLIS IN
46217-9291
US

V. Phone/Fax

Practice location:
  • Phone: 317-791-9031
  • Fax: 317-791-9001
Mailing address:
  • Phone: 317-791-9031
  • Fax: 317-791-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05016497A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: