Provider Demographics
NPI:1033152764
Name:THERAPY ETC INC
Entity Type:Organization
Organization Name:THERAPY ETC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DRISCOLL-BELL
Authorized Official - Suffix:
Authorized Official - Credentials:PTA, BS
Authorized Official - Phone:765-430-0795
Mailing Address - Street 1:6433 WEA WOODLANDS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8912
Mailing Address - Country:US
Mailing Address - Phone:765-430-0795
Mailing Address - Fax:765-538-2230
Practice Address - Street 1:6433 WEA WOODLANDS DRIVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-8912
Practice Address - Country:US
Practice Address - Phone:765-538-2230
Practice Address - Fax:765-538-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05000258A225100000X
IN31002254A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN233860Medicare ID - Type Unspecified