Provider Demographics
NPI:1124540125
Name:HUGHES, SALLY K
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:K
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9011 N MERIDIAN ST STE 112
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2399
Mailing Address - Country:US
Mailing Address - Phone:317-571-0017
Mailing Address - Fax:
Practice Address - Street 1:9011 N MERIDIAN ST STE 112
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2399
Practice Address - Country:US
Practice Address - Phone:317-571-0017
Practice Address - Fax:317-571-1555
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002242A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation