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General NPI Number Information
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NPI Number | 1548682537
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Entity Type | Organization
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Legal Business Name | TAI LLC
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 5140 CHARLESTOWN RD SUIT 1A
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City | NEW ALBANY
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State | IN
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Zip | 47150-9475
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Country | US
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Telephone | 812-972-7724
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Fax | 812-572-4696
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Provider Business Mailing Address
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Address Line | 5140 CHARLESTOWN RD SUIT 1A
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City | NEW ALBANY
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State | IN
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Zip | 47150-9475
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Country | US
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Telephone | 812-972-7724
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Fax | 812-572-4696
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEROME A JOHANNES
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Credential | PT,DPT
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Telephone | 812-972-7724
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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 | 05003469A
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License Number State | IN
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