MEDICARE: DAVID A GIRARDOT DPT

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	71011576A	IN
2	225100000X	Physical Therapist	8497	MN

General Provider Information

NPI Number	:	1407167299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID A GIRARDOT DPT

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3415 HOBSON RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-1617
Country	:	US
Telephone Number	:	260-373-9318
Fax Number	:	260-373-9301

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

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	01/24/2022

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Directions to “ DAVID A GIRARDOT DPT” Practice Location

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