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General NPI Number Information
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NPI Number | 1821540030
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Entity Type | Organization
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Legal Business Name | ST MARY'S THERAPY NORTHSIDE
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 14020 OLD STATE RD STE D100
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City | EVANSVILLE
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State | IN
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Zip | 47725-1164
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Country | US
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Telephone | 812-469-4770
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Fax | 812-469-4794
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Provider Business Mailing Address
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Address Line | 14020 OLD STATE RD STE D100
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City | EVANSVILLE
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State | IN
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Zip | 47725-1164
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Country | US
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Telephone | 812-469-4770
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Fax | 812-469-4794
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Authorized Official
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Title or Position | PTA
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Name | MRS. CHRISTINA K BINHACK
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Credential |
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Telephone | 812-469-4770
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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 | 06001428A
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License Number State | IN
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