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General NPI Number Information
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NPI Number | 1407273519
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Entity Type | Organization
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Legal Business Name | JMC PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 406 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5000
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Country | US
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Telephone | 812-320-2242
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Fax | 812-332-4562
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Provider Business Mailing Address
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Address Line | 406 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5000
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Country | US
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Telephone | 812-320-2242
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Fax | 812-332-4562
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | NANCY K CATANELLA
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Credential | RMC
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Telephone | 702-407-3045
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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 | 05005047A
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License Number State | IN
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