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General NPI Number Information
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NPI Number | 1962987255
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Entity Type | Organization
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Legal Business Name | PTWORX LLC
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 5006 S ROGERS ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-4655
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Country | US
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Telephone | 812-361-6989
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Fax |
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Provider Business Mailing Address
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Address Line | 3509 S GLASGOW CIR
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City | BLOOMINGTON
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State | IN
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Zip | 47403-7900
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Country | US
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Telephone | 917-361-2260
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CHRISTIAN VILLANUEVA SALVA
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Credential |
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Telephone | 812-269-2679
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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 |
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License Number State |
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