Provider Demographics
NPI:1508063652
Name:LAPORTE REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:LAPORTE REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPISTS' ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:219-326-2397
Mailing Address - Street 1:1203 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3221
Mailing Address - Country:US
Mailing Address - Phone:219-326-2397
Mailing Address - Fax:
Practice Address - Street 1:1203 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3221
Practice Address - Country:US
Practice Address - Phone:219-326-2397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001316A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty