MEDICARE: LAMMAS,LLC

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	05002822A	IN

General Provider Information

NPI Number	:	1033503750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAMMAS,LLC

Provider Business Mailing Address
First Line	:	6211 E PLEASANT RIDGE RD
Second Line	:
City	:	MADISON
State	:	IN
Zip	:	47250-7408
Country	:	US
Telephone Number	:	812-801-1362
Fax Number	:	888-768-6471

Provider Business Practice Location Address
First Line	:	2560 N COUNTY ROAD 20 W
Second Line	:
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-8202
Country	:	US
Telephone Number	:	812-801-1362
Fax Number	:	888-768-6471

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK DOUGLAS SIMMONS
Credential	:	PT
Telephone Number	:	812-801-1362

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	04/25/2015

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