MEDICARE: BRITTANY N CHESTNUT P.T.A.

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	225200000X	Physical Therapy Assistant	06003427A	IN

General Provider Information

NPI Number	:	1043521677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY N CHESTNUT P.T.A.

Provider Business Mailing Address
First Line	:	4834 S STATE ROAD 57
Second Line	:
City	:	WASHINGTON
State	:	IN
Zip	:	47501-7444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4834 S STATE ROAD 57
Second Line	:
City	:	WASHINGTON
State	:	IN
Zip	:	47501-7444
Country	:	US
Telephone Number	:	812-257-1067
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2010
Last Update Date	:	06/29/2010

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