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General NPI Number Information
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NPI Number | 1477066769
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Entity Type | Organization
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Legal Business Name | VITALIZE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 01/29/2019
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Provider Practice Location Address
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Address Line | 109 N UNION ST
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City | WESTFIELD
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State | IN
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Zip | 46074-9459
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Country | US
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Telephone | 317-983-2321
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Fax |
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Provider Business Mailing Address
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Address Line | 321 E COLUMBINE LN
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City | WESTFIELD
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State | IN
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Zip | 46074-9782
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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 | NATALIE MARSHALL
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Credential | DPT
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Telephone | 260-243-0348
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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 |
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License Number State |
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