Healthcare Provider Details

I. General information

NPI: 1164658688
Provider Name (Legal Business Name): COURTNEY DANIELLE ESLICK PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5949 W RAYMOND ST
INDIANAPOLIS IN
46241-4348
US

IV. Provider business mailing address

5949 W RAYMOND ST
INDIANAPOLIS IN
46241-4348
US

V. Phone/Fax

Practice location:
  • Phone: 317-390-5575
  • Fax: 317-486-2189
Mailing address:
  • Phone: 317-390-5575
  • Fax: 317-486-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06003851A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: