Provider Demographics
NPI:1639180102
Name:HINES, POLLY ANN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:ANN
Last Name:HINES
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7112 ZIONSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2163
Mailing Address - Country:US
Mailing Address - Phone:317-329-1000
Mailing Address - Fax:317-329-1001
Practice Address - Street 1:7112 ZIONSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2163
Practice Address - Country:US
Practice Address - Phone:317-329-1000
Practice Address - Fax:317-329-1001
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005028A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000365562OtherANTHEM REGISTERED PT