MEDICARE: MR. ALLEN L SLIGHT PT

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	05006085A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05006085A	OTHER	IN	PHYSICAL THERAPIST LICENS
2	000000333863	OTHER	IN	ANTHEM BLUE CROSS #

General Provider Information

NPI Number	:	1255338919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALLEN L SLIGHT PT

Provider Business Mailing Address
First Line	:	402 W MARKET ST
Second Line	:
City	:	CRAWFORDSVILLE
State	:	IN
Zip	:	47933-1634
Country	:	US
Telephone Number	:	765-362-6740
Fax Number	:	765-362-6750

Provider Business Practice Location Address
First Line	:	402 W MARKET ST
Second Line	:
City	:	CRAWFORDSVILLE
State	:	IN
Zip	:	47933-1634
Country	:	US
Telephone Number	:	765-362-6740
Fax Number	:	765-362-6750

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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