MEDICARE: NORTHWEST INDIANA THERAPY CENTER, 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	225100000X	Physical Therapist	05008772A	IN
2	2278P1005X	Pulmonary Rehabilitation Certified Respiratory Therapist	30003890A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275615361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST INDIANA THERAPY CENTER, LLC

Provider Business Mailing Address
First Line	:	2635 45TH ST
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2635 45TH ST
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2902
Country	:	US
Telephone Number	:	219-924-3108
Fax Number	:	219-924-3109

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MR. ANDREW TEIBEL
Credential	:
Telephone Number	:	219-924-3108

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	09/11/2025

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