Provider Demographics
NPI:1508012733
Name:THERA-PLUS P.C.
Entity Type:Organization
Organization Name:THERA-PLUS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:765-348-4489
Mailing Address - Street 1:410 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HARTFORD CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47348-8828
Mailing Address - Country:US
Mailing Address - Phone:765-348-4489
Mailing Address - Fax:765-348-9890
Practice Address - Street 1:410 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:HARTFORD CITY
Practice Address - State:IN
Practice Address - Zip Code:47348-8828
Practice Address - Country:US
Practice Address - Phone:765-348-4489
Practice Address - Fax:765-348-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001672A174400000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200715480AMedicaid