Healthcare Provider Details

I. General information

NPI: 1508532912
Provider Name (Legal Business Name): CARA NICOLE EMENHISER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HADLEY RD
MOORESVILLE IN
46158-1737
US

IV. Provider business mailing address

8111 S EMERSON AVE
INDIANAPOLIS IN
46237-8601
US

V. Phone/Fax

Practice location:
  • Phone: 317-831-9333
  • Fax:
Mailing address:
  • Phone: 317-528-8578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05014320A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: