Healthcare Provider Details

I. General information

NPI: 1811303399
Provider Name (Legal Business Name): RCA PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8691 CONNECTICUT ST STE C
MERRILLVILLE IN
46410-5541
US

IV. Provider business mailing address

PO BOX 10644
MERRILLVILLE IN
46411-0644
US

V. Phone/Fax

Practice location:
  • Phone: 219-525-4176
  • Fax: 219-472-0841
Mailing address:
  • Phone: 219-525-4176
  • Fax: 219-750-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: FATAI BOLAJI ADISA
Title or Position: ADMINISTRATOR
Credential: P.T., D.P.T
Phone: 219-313-0763