=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043813975
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASCEND PHYSICAL THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2020
-----------------------------------------------------
Last Update Date | 11/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7101 S SAGINAW PL
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47802-9719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-562-8142
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7101 S SAGINAW PL
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47802-9719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-562-8142
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | STEVIE A SHEW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 618-562-8142
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081S0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------