Healthcare Provider Details

I. General information

NPI: 1457178436
Provider Name (Legal Business Name): MIRACLES REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3806 AMELIA AVE
LAFAYETTE IN
47905-5772
US

IV. Provider business mailing address

3806 AMELIA AVE
LAFAYETTE IN
47905-5772
US

V. Phone/Fax

Practice location:
  • Phone: 765-807-2773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAVID CPBB
Title or Position: OWNER/PT
Credential:
Phone: 765-714-5033