MEDICARE: PHYSIOTHERAPY ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000175000	OTHER	IN	OTHER

General Provider Information

NPI Number	:	1013096668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSIOTHERAPY ASSOCIATES INC

Provider Business Mailing Address
First Line	:	155 DIPLOMAT DR
Second Line	:
City	:	COLUMBIA CITY
State	:	IN
Zip	:	46725-1330
Country	:	US
Telephone Number	:	260-248-4412
Fax Number	:	260-248-4417

Provider Business Practice Location Address
First Line	:	155 DIPLOMAT DR STE D
Second Line	:
City	:	COLUMBIA CITY
State	:	IN
Zip	:	46725-1331
Country	:	US
Telephone Number	:	260-248-4412
Fax Number	:	260-248-4417

Authorized Official
Title or Position	:	CONTRACTING
Name	:	ROB ZIGENFUS JR.
Credential	:
Telephone Number	:	901-685-7227

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	08/07/2007

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