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General NPI Number Information
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NPI Number | 1407118276
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Entity Type | Organization
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Legal Business Name | PRIORITY REHAB
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 890 E 116TH ST SUITE 142
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City | CARMEL
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State | IN
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Zip | 46032-3475
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Country | US
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Telephone | 317-989-3578
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Fax |
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Provider Business Mailing Address
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Address Line | 13426 LOST CREEK LN
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City | CARMEL
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State | IN
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Zip | 46074-5836
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BLAKE WISEMAN
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Credential | DPT
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Telephone | 317-989-3578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05009422A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31005549A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 46002474A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05009661A
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License Number State | IN
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