Provider Demographics
NPI:1306829874
Name:SOWASH, BECKY M (PT)
Entity Type:Individual
Prefix:MS
First Name:BECKY
Middle Name:M
Last Name:SOWASH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:BECKY
Other - Middle Name:M
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5214 S EAST ST
Mailing Address - Street 2:BLDG D STE 1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227
Mailing Address - Country:US
Mailing Address - Phone:800-486-4449
Mailing Address - Fax:317-780-3745
Practice Address - Street 1:5214 S EAST ST
Practice Address - Street 2:BLDG D STE 1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227
Practice Address - Country:US
Practice Address - Phone:800-486-4449
Practice Address - Fax:317-780-3745
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002986A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist