MEDICARE: HEIDI RAE STOUT P.T.

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	225100000X	Physical Therapist	05005096A	IN

General Provider Information

NPI Number	:	1184669400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI RAE STOUT P.T.

Provider Business Mailing Address
First Line	:	9102 N MERIDIAN ST
Second Line	:	STE 415
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1860
Country	:	US
Telephone Number	:	317-581-1890
Fax Number	:	317-581-2436

Provider Business Practice Location Address
First Line	:	9102 N MERIDIAN ST
Second Line	:	STE 415
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1860
Country	:	US
Telephone Number	:	317-581-1890
Fax Number	:	317-581-2436

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/08/2007

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Directions to “ HEIDI RAE STOUT P.T.” Practice Location

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