Healthcare Provider Details

I. General information

NPI: 1144420563
Provider Name (Legal Business Name): DARLA J LINGLE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS DARLA J CUMMINS

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 HICKORY RD
MISHAWAKA IN
46545-8865
US

IV. Provider business mailing address

401 W HARRISON ST
WAKARUSA IN
46573-9583
US

V. Phone/Fax

Practice location:
  • Phone: 574-252-7225
  • Fax:
Mailing address:
  • Phone: 574-862-2936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05005273A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: