Healthcare Provider Details

I. General information

NPI: 1306244231
Provider Name (Legal Business Name): INDIANA PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 LAKE CITY HWY.
WARSAW IN
46580
US

IV. Provider business mailing address

4251 LAHMEYER RD
FORT WAYNE IN
46815
US

V. Phone/Fax

Practice location:
  • Phone: 574-306-2912
  • Fax: 574-306-2922
Mailing address:
  • Phone: 260-432-4700
  • Fax: 260-459-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DRU NICHOLE BISHOP
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 260-432-4700