MEDICARE: PHYSIOTHERAPY ASSOCIATES

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		IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000175000	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1417027772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSIOTHERAPY ASSOCIATES

Provider Business Mailing Address
First Line	:	3250 PLAYERS CLUB PKWY
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-8844
Country	:	US
Telephone Number	:	901-685-7227
Fax Number	:	901-748-3492

Provider Business Practice Location Address
First Line	:	2464 GETZ RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1632
Country	:	US
Telephone Number	:	260-436-9710
Fax Number	:	260-436-9419

Authorized Official
Title or Position	:	CONTROLLER
Name	:	STEVE LEECH
Credential	:
Telephone Number	:	901-685-7227

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/22/2020

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Directions to “PHYSIOTHERAPY ASSOCIATES ” Practice Location

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