Healthcare Provider Details

I. General information

NPI: 1225350002
Provider Name (Legal Business Name): REPUSTAFF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 KEYSTONE XING SUITE 600
INDIANAPOLIS IN
46240-7670
US

IV. Provider business mailing address

8900 KEYSTONE XING SUITE 600
INDIANAPOLIS IN
46240-7670
US

V. Phone/Fax

Practice location:
  • Phone: 317-218-0654
  • Fax: 317-218-0684
Mailing address:
  • Phone: 317-218-0654
  • Fax: 317-218-0684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GERRY ERB
Title or Position: COO
Credential:
Phone: 317-218-0654