MEDICARE: STEPHANIE ROSE GANLEY PT

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	05005645A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05013796A	OTHER	IN	APTA

General Provider Information

NPI Number	:	1588274252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ROSE GANLEY PT

Provider Business Mailing Address
First Line	:	7440 N SHADELAND AVE STE 130
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2027
Country	:	US
Telephone Number	:	317-577-7333
Fax Number	:	317-577-7330

Provider Business Practice Location Address
First Line	:	7440 N SHADELAND AVE STE 130
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2027
Country	:	US
Telephone Number	:	317-577-7333
Fax Number	:	317-577-7330

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

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	08/06/2020

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Directions to “ STEPHANIE ROSE GANLEY PT” Practice Location

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