Provider Demographics
NPI:1063813566
Name:ORTHOPAEDIC AND SPORTS PHYSICAL THERAPY OF INDIANA, INC.
Entity Type:Organization
Organization Name:ORTHOPAEDIC AND SPORTS PHYSICAL THERAPY OF INDIANA, INC.
Other - Org Name:ZIONSVILLE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-873-2033
Mailing Address - Street 1:77 BOONE VLG
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1231
Mailing Address - Country:US
Mailing Address - Phone:317-873-2033
Mailing Address - Fax:317-873-8934
Practice Address - Street 1:77 BOONE VLG
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1231
Practice Address - Country:US
Practice Address - Phone:317-873-2033
Practice Address - Fax:317-873-8934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN254240Medicare PIN