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NPI Code Detail

MEDICARE: ANGIE MARIE DYKSTRA PT

MEDICARE: ANGIE MARIE DYKSTRA 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
1225100000XPhysical Therapist05007765AIN

General Provider Information

NPI Number : 1407021108
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGIE MARIE DYKSTRA PT
Provider Business Mailing Address
First Line : 1531 WATERFORD DR
Second Line :
City : ZIONSVILLE
State : IN
Zip : 46077-3818
Country : US
Telephone Number : 317-873-6697
Fax Number :
Provider Business Practice Location Address
First Line : 5936 N KEYSTONE AVE
Second Line : SUITE 101
City : INDIANAPOLIS
State : IN
Zip : 46220-2458
Country : US
Telephone Number : 317-257-8340
Fax Number : 317-257-8361
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2008
Last Update Date : 04/24/2008

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Directions to “ ANGIE MARIE DYKSTRA PT” Practice Location

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