MEDICARE: HOOSIER PHYSICAL THERAPY

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	174400000X	Specialist		IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000112072	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1487862207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOOSIER PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 2574
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46801-2574
Country	:	US
Telephone Number	:	419-539-7701
Fax Number	:	419-539-7718

Provider Business Practice Location Address
First Line	:	3217 LAKE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5427
Country	:	US
Telephone Number	:	419-539-7701
Fax Number	:	419-539-7718

Authorized Official
Title or Position	:	MANAGER
Name	:	JUDY SINK
Credential	:
Telephone Number	:	419-539-7701

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	08/22/2020

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Directions to “HOOSIER PHYSICAL THERAPY ” Practice Location

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