Healthcare Provider Details

I. General information

NPI: 1699822023
Provider Name (Legal Business Name): AMERICAN PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 CRAWFORDSVILLE RD BUILDING #13
INDIANAPOLIS IN
46224-3727
US

IV. Provider business mailing address

5610 CRAWFORDSVILLE RD BUILDING #13
INDIANAPOLIS IN
46224-3727
US

V. Phone/Fax

Practice location:
  • Phone: 317-487-6105
  • Fax: 317-487-8499
Mailing address:
  • Phone: 317-487-6105
  • Fax: 317-487-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DAWN MARIE MARTIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 317-487-6105