Provider Demographics
NPI:1568694719
Name:INDIANA TOTAL THERAPY
Entity Type:Organization
Organization Name:INDIANA TOTAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-357-7271
Mailing Address - Street 1:2354 RTE 119 HWY S
Mailing Address - Street 2:
Mailing Address - City:HOMER CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15748-7325
Mailing Address - Country:US
Mailing Address - Phone:724-479-2259
Mailing Address - Fax:724-479-2280
Practice Address - Street 1:2354 RTE 119 HWY S
Practice Address - Street 2:
Practice Address - City:HOMER CITY
Practice Address - State:PA
Practice Address - Zip Code:15748-7325
Practice Address - Country:US
Practice Address - Phone:724-479-2259
Practice Address - Fax:724-479-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6223510002Medicare NSC