Healthcare Provider Details

I. General information

NPI: 1811014681
Provider Name (Legal Business Name): THE CENTER FOR SPORTS & PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 S ADAMS ST
MARION IN
46953-5349
US

IV. Provider business mailing address

4411 S ADAMS ST
MARION IN
46953-5349
US

V. Phone/Fax

Practice location:
  • Phone: 765-674-4455
  • Fax: 765-674-3577
Mailing address:
  • Phone: 765-674-4455
  • Fax: 765-674-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIMOTHY PURDOM
Title or Position: ADMINISTRATOR
Credential:
Phone: 765-674-4455