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General NPI Number Information
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NPI Number | 1578597654
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 7114 GALEN DR W STE 200
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City | AVON
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State | IN
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Zip | 46123-8658
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Country | US
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Telephone | 317-272-9700
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Fax | 317-272-9200
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Provider Business Mailing Address
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Address Line | 7114 GALEN DR W STE 200
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City | AVON
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State | IN
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Zip | 46123-8658
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Country | US
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Telephone | 317-272-9700
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Fax | 317-272-9200
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD G WEBER
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Credential | P.T.
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Telephone | 317-272-9700
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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 | 05000640A
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License Number State | IN
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