Healthcare Provider Details

I. General information

NPI: 1013204809
Provider Name (Legal Business Name): ELIZABETH LESTEE GARRETT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 N SHADELAND AVE
INDIANAPOLIS IN
46250-2021
US

IV. Provider business mailing address

12247 BRANGTON DR
FISHERS IN
46037-8202
US

V. Phone/Fax

Practice location:
  • Phone: 317-288-7606
  • Fax: 317-288-7607
Mailing address:
  • Phone: 812-598-9497
  • Fax: 317-288-7607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number05009050A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: