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General NPI Number Information
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NPI Number | 1275738221
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Entity Type | Organization
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Legal Business Name | TOTAL LIFE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 5 PUBLIC SQ
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City | SALEM
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State | IN
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Zip | 47167-2050
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Country | US
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Telephone | 812-883-5454
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Fax | 812-883-6464
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Provider Business Mailing Address
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Address Line | PO BOX 425
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City | SALEM
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State | IN
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Zip | 47167-0425
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Country | US
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Telephone | 812-883-5454
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Fax | 812-883-6464
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA M MARTIN
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Credential | PT
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Telephone | 812-883-5454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 05008539A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | IL
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