Healthcare Provider Details

I. General information

NPI: 1942449699
Provider Name (Legal Business Name): INDIANA FITNESS WORKS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9190 PRIORITY WAY WEST DR STE 110
INDIANAPOLIS IN
46240-1437
US

IV. Provider business mailing address

9190 PRIORITY WAY WEST DR STE 110
INDIANAPOLIS IN
46240-1437
US

V. Phone/Fax

Practice location:
  • Phone: 317-805-4963
  • Fax: 317-818-0720
Mailing address:
  • Phone: 317-805-4963
  • Fax: 317-818-0720

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

VIII. Authorized Official

Name: MRS. SUZANNE PATTERSON-REED
Title or Position: PRESIDENT
Credential: M.S. CCC/SLP
Phone: 317-805-4963