MEDICARE: PAULA MARIE ENYEART MPT

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	05010052A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	156546	OTHER	IN	MEDICARE - GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508193277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA MARIE ENYEART MPT

Provider Business Mailing Address
First Line	:	4251 LAHMEYER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5676
Country	:	US
Telephone Number	:	260-432-4700
Fax Number	:	260-459-9262

Provider Business Practice Location Address
First Line	:	7930 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4140
Country	:	US
Telephone Number	:	260-432-5800
Fax Number	:	260-432-9555

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

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	05/16/2011

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Directions to “ PAULA MARIE ENYEART MPT” Practice Location

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