MEDICARE: CONCEPT THERAPY PROFESSIONAL CORPORATION

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	05005298A	IN
2	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

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	:	1497824577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCEPT THERAPY PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	524 E MCKINLEY AVE
Second Line	:	SUITE 1
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-6285
Country	:	US
Telephone Number	:	574-255-8730
Fax Number	:	574-255-8732

Provider Business Practice Location Address
First Line	:	3222 MISHAWAKA AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-2352
Country	:	US
Telephone Number	:	574-255-8730
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	ARKADIUSZ M DEBICKI
Credential	:	PT
Telephone Number	:	574-255-8730

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	12/07/2022

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Directions to “CONCEPT THERAPY PROFESSIONAL CORPORATION ” Practice Location

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