Provider Demographics
NPI:1558428482
Name:PHYSIOTHERAPY ASSOCIATES INC
Entity Type:Organization
Organization Name:PHYSIOTHERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIGENFUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-685-7227
Mailing Address - Street 1:301 E NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2116
Mailing Address - Country:US
Mailing Address - Phone:317-951-4030
Mailing Address - Fax:317-951-4035
Practice Address - Street 1:301 E NEW YORK ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-2116
Practice Address - Country:US
Practice Address - Phone:317-951-4030
Practice Address - Fax:317-951-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008871A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN156529Medicare Oscar/Certification
IN000000387233Medicare UPIN