Provider Demographics
NPI:1407902679
Name:ALL AGES IN PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ALL AGES IN PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLINA
Authorized Official - Middle Name:HERNANDEZ
Authorized Official - Last Name:ANOG-NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:574-225-0682
Mailing Address - Street 1:840 E STATE ROAD 14
Mailing Address - Street 2:
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996-7755
Mailing Address - Country:US
Mailing Address - Phone:574-225-0682
Mailing Address - Fax:574-946-4775
Practice Address - Street 1:840 E STATE ROAD 14
Practice Address - Street 2:
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-7755
Practice Address - Country:US
Practice Address - Phone:574-225-0682
Practice Address - Fax:574-946-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN5004043A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty