Healthcare Provider Details

I. General information

NPI: 1942136569
Provider Name (Legal Business Name): KORY ANN THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 LAKE CIRCLE DR
INDIANAPOLIS IN
46268-4931
US

IV. Provider business mailing address

2319 N PENNSYLVANIA ST
INDIANAPOLIS IN
46205-4343
US

V. Phone/Fax

Practice location:
  • Phone: 812-870-2307
  • Fax:
Mailing address:
  • Phone: 812-870-2307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013273A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: