Healthcare Provider Details

I. General information

NPI: 1740260595
Provider Name (Legal Business Name): VIMAL SHARMA R.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000, EAGLE RIDGE DRIVE SUITE B
SCHERERVILLE IN
46375
US

IV. Provider business mailing address

1000 EAGLE RIDGE DR STE B
SCHERERVILLE IN
46375-4208
US

V. Phone/Fax

Practice location:
  • Phone: 219-805-6897
  • Fax: 219-922-9143
Mailing address:
  • Phone: 219-922-9143
  • Fax: 219-922-9143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05005321A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: