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General NPI Number Information
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NPI Number | 1659445286
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Entity Type | Organization
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Legal Business Name | PORTER COUNTY PHYSICAL MED REHAB
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2600 N ROOSEVELT ROAD STE 200 3
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City | VALPARAISO
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State | IN
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Zip | 46383-0970
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Country | US
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Telephone | 219-548-3828
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Fax | 219-548-3803
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Provider Business Mailing Address
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Address Line | 2600 N ROOSEVELT ROAD STE 200 3
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City | VALPARAISO
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State | IN
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Zip | 46383-0970
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Country | US
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Telephone | 219-548-3828
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Fax | 219-548-3803
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Authorized Official
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Title or Position | INS COORDINATOR
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Name | MISS LISA M HAYES
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Credential |
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Telephone | 219-548-3828
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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 | 05003279A
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License Number State | IN
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