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General NPI Number Information
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NPI Number | 1467775742
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Entity Type | Organization
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Legal Business Name | RACOVI THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 8146 BIRCHFIELD DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-2895
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Country | US
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Telephone | 812-841-9410
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Fax | 317-755-1773
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Provider Business Mailing Address
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Address Line | PO BOX 681401
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-7401
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Country | US
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Telephone | 812-841-9410
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Fax | 317-755-1773
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Authorized Official
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Title or Position | OWNER
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Name | RAYMOND CORTES VILLANUEVA
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Credential | PT
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Telephone | 812-841-9410
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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 |
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License Number State |
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