Physician Compare National (NPI:1902036353)

HEALTHCARE PROVIDER: COLLEEN LEE INDERMILL RPT

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1902036353
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2961626841
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140616001500
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	INDERMILL
	Individual professional last name
Provider First Name	COLLEEN
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL THERAPY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	RELIEF PHYSICAL THERAPY, INC.
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	9234163809
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	27225 CAMP PLENTY RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 6
	Group Practice or individual's line 2 address
City	CANYON COUNTRY
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	913512654
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6612980140
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y