Provider Demographics
NPI:1518335116
Name:HARDCASTLE, JO ANN MICHELLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JO ANN
Middle Name:MICHELLE
Last Name:HARDCASTLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S 900 W 27
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:IN
Mailing Address - Zip Code:46919-9390
Mailing Address - Country:US
Mailing Address - Phone:765-667-1647
Mailing Address - Fax:
Practice Address - Street 1:406 S 900 W 27
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:IN
Practice Address - Zip Code:46919-9390
Practice Address - Country:US
Practice Address - Phone:765-667-1647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06005088A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant