Healthcare Provider Details

I. General information

NPI: 1538392436
Provider Name (Legal Business Name): INDIANA TOTAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 SHELLY DRIVE
INDIANA PA
15701-2385
US

IV. Provider business mailing address

2010 SHELLY DRIVE
INDIANA PA
15701-2385
US

V. Phone/Fax

Practice location:
  • Phone: 724-349-2276
  • Fax: 724-801-8558
Mailing address:
  • Phone: 724-349-2276
  • Fax: 724-801-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JONI L MILCHAK
Title or Position: OFFICE MANAGER
Credential:
Phone: 724-357-7271