Healthcare Provider Details

I. General information

NPI: 1134563273
Provider Name (Legal Business Name): ACHIEVE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E 34TH ST
INDIANAPOLIS IN
46205-3408
US

IV. Provider business mailing address

107 E 34TH ST
INDIANAPOLIS IN
46205-3408
US

V. Phone/Fax

Practice location:
  • Phone: 317-426-3477
  • Fax: 317-622-2971
Mailing address:
  • Phone: 317-426-3477
  • Fax: 317-622-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number05004050A
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number05004058A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05004058A
License Number StateIN

VIII. Authorized Official

Name: LORETO BAYANI
Title or Position: PRESIDENT
Credential: PT
Phone: 765-453-8855