Provider Demographics
NPI:1063816262
Name:UNITED THERAPY & SPORTS MEDICINE
Entity Type:Organization
Organization Name:UNITED THERAPY & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:AKINBOBUYI
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:219-769-0711
Mailing Address - Street 1:6966 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3696
Mailing Address - Country:US
Mailing Address - Phone:219-769-0711
Mailing Address - Fax:
Practice Address - Street 1:6966 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3696
Practice Address - Country:US
Practice Address - Phone:219-769-0711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002378A225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty