Healthcare Provider Details

I. General information

NPI: 1487863114
Provider Name (Legal Business Name): PAULA A CROSS PHYS THERAPIST ASST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 VIRGINIA ST
MERRILLVILLE IN
46410-6231
US

IV. Provider business mailing address

2909 W 73RD PL
MERRILLVILLE IN
46410-4501
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-9009
  • Fax:
Mailing address:
  • Phone: 219-769-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002522A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: