Healthcare Provider Details

I. General information

NPI: 1033152764
Provider Name (Legal Business Name): THERAPY ETC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6433 WEA WOODLANDS DRIVE
LAFAYETTE IN
47909-8912
US

IV. Provider business mailing address

6433 WEA WOODLANDS DRIVE
LAFAYETTE IN
47909-8912
US

V. Phone/Fax

Practice location:
  • Phone: 765-538-2230
  • Fax: 765-538-2230
Mailing address:
  • Phone: 765-430-0795
  • Fax: 765-538-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31002254A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05000258A
License Number StateIN

VIII. Authorized Official

Name: MRS. PATRICE M DRISCOLL-BELL
Title or Position: PRESIDENT
Credential: PTA, BS
Phone: 765-430-0795