Provider Demographics
NPI:1568501567
Name:WISHKIDS INTERNATIONAL
Entity Type:Organization
Organization Name:WISHKIDS INTERNATIONAL
Other - Org Name:WISH THERAPEUTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOGA
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:317-280-8266
Mailing Address - Street 1:6825 PARKDALE PL
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-6603
Mailing Address - Country:US
Mailing Address - Phone:317-280-8266
Mailing Address - Fax:317-280-8266
Practice Address - Street 1:6825 PARKDALE PLACE
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254
Practice Address - Country:US
Practice Address - Phone:317-280-8266
Practice Address - Fax:317-280-8266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004940A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05004940AMedicare ID - Type UnspecifiedPHYSICAL THERAPIST