Provider Demographics
NPI:1508193277
Name:ENYEART, PAULA MARIE (MPT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:ENYEART
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:MARIE
Other - Last Name:SCHLUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:4251 LAHMEYER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5676
Mailing Address - Country:US
Mailing Address - Phone:260-432-4700
Mailing Address - Fax:260-459-9262
Practice Address - Street 1:7930 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-432-5800
Practice Address - Fax:260-432-9555
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010052A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN156546OtherMEDICARE - GROUP
IN200965280AMedicaid
IN100257920OtherMEDICAID - GROUP