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General NPI Number Information
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NPI Number | 1427384858
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Entity Type | Organization
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Legal Business Name | THERAPRO LLC
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 10/20/2009
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Provider Practice Location Address
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Address Line | 306 1/2 MAIN STREET
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City | JASPER
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State | IN
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Zip | 47546
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Country | US
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Telephone | 812-639-6235
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Fax |
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Provider Business Mailing Address
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Address Line | 1409 PARK ST
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City | JASPER
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State | IN
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Zip | 47546-2007
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Country | US
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Telephone | 812-639-6235
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Fax | 707-929-2359
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MR. STEVE W. DYSERT
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Credential | OT
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Telephone | 812-639-6235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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