Provider Demographics
NPI:1609277417
Name:ARCHER, ADDISON LAURA (DPT)
Entity Type:Individual
Prefix:
First Name:ADDISON
Middle Name:LAURA
Last Name:ARCHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ADDISON
Other - Middle Name:LAURA
Other - Last Name:SCHNEBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:17471 WHEELER RD STE 114
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-6903
Mailing Address - Country:US
Mailing Address - Phone:317-275-6131
Mailing Address - Fax:317-275-7140
Practice Address - Street 1:17471 WHEELER RD STE 114
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074
Practice Address - Country:US
Practice Address - Phone:317-275-6131
Practice Address - Fax:317-275-7140
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011711A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist