Provider Demographics
NPI:1497979124
Name:THERATOT, INC
Entity Type:Organization
Organization Name:THERATOT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANI
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-694-4056
Mailing Address - Street 1:3875 S HERITAGE CT
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-9108
Mailing Address - Country:US
Mailing Address - Phone:317-694-4956
Mailing Address - Fax:317-861-0472
Practice Address - Street 1:3875 S HERITAGE CT
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-9108
Practice Address - Country:US
Practice Address - Phone:317-694-4956
Practice Address - Fax:317-861-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05000560A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200723400AMedicaid
IN200666310Medicaid