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NPI Code Detail

MEDICARE: ELIZA B DICK DPT

MEDICARE: ELIZA B DICK 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
1225100000XPhysical Therapist05011731AIN

General Provider Information

NPI Number : 1568846384
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZA B DICK DPT
Provider Business Mailing Address
First Line : 1036 BROADWAY ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-3781
Country : US
Telephone Number : 847-363-1877
Fax Number :
Provider Business Practice Location Address
First Line : 2002 W 86TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-1903
Country : US
Telephone Number : 317-872-8811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2015
Last Update Date : 11/08/2021

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Directions to “ ELIZA B DICK DPT” Practice Location

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