Provider Demographics
NPI:1629018569
Name:CENTRAL INDIANA REHABILITATIVE SERVICES INC
Entity Type:Organization
Organization Name:CENTRAL INDIANA REHABILITATIVE SERVICES INC
Other - Org Name:GREENCASTLE PHSYICAL THERAPY & SPORTS MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHET
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLODFELTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:765-653-8494
Mailing Address - Street 1:1003 MILL POND LANE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135
Mailing Address - Country:US
Mailing Address - Phone:765-653-8494
Mailing Address - Fax:765-653-7835
Practice Address - Street 1:1003 MILL POND LANE
Practice Address - Street 2:SUITE C
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135
Practice Address - Country:US
Practice Address - Phone:765-653-8494
Practice Address - Fax:765-653-7835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
05002491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
156542Medicare ID - Type Unspecified