Provider Demographics
NPI:1427384858
Name:THERAPRO LLC
Entity Type:Organization
Organization Name:THERAPRO LLC
Other - Org Name:THERAPRO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:W
Authorized Official - Last Name:DYSERT
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:812-639-6235
Mailing Address - Street 1:1409 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2007
Mailing Address - Country:US
Mailing Address - Phone:812-639-6235
Mailing Address - Fax:707-929-2359
Practice Address - Street 1:306 1/2 MAIN STREET
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546
Practice Address - Country:US
Practice Address - Phone:812-639-6235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation