Provider Demographics
NPI:1568679546
Name:THORDARSON, DARCI (PT)
Entity Type:Individual
Prefix:
First Name:DARCI
Middle Name:
Last Name:THORDARSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5267 IVY HILL DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8989
Mailing Address - Country:US
Mailing Address - Phone:317-574-1416
Mailing Address - Fax:
Practice Address - Street 1:5570 PEBBLE VILLAGE LN
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-7408
Practice Address - Country:US
Practice Address - Phone:317-770-9223
Practice Address - Fax:317-770-9266
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.013438225100000X
IN05010127A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist