Provider Demographics
NPI:1043490758
Name:JAIN, HITESH KUMAR (PT)
Entity Type:Individual
Prefix:
First Name:HITESH KUMAR
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11251 NIAGARA DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4309
Mailing Address - Country:US
Mailing Address - Phone:317-748-3073
Mailing Address - Fax:
Practice Address - Street 1:11251 NIAGARA DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-4309
Practice Address - Country:US
Practice Address - Phone:317-748-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008569A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist