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General NPI Number Information
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NPI Number | 1790854040
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Entity Type | Organization
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Legal Business Name | EARTHWORKS CENTER INC.
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 7725 BROADWAY SUITE A
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City | MERRILLVILLE
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State | IN
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Zip | 46410-4731
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Country | US
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Telephone | 219-794-0029
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Fax | 219-794-0065
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Provider Business Mailing Address
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Address Line | 7725 BROADWAY SUITE A
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City | MERRILLVILLE
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State | IN
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Zip | 46410
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Country | US
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Telephone | 219-794-0029
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Fax | 219-794-0065
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KARLENE M. CANTRELL
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Credential | R.P.T
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Telephone | 219-794-0029
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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 | 05001346A
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License Number State | IN
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