Provider Demographics
NPI:1700021912
Name:ROBERT J AMICO PT INC
Entity Type:Organization
Organization Name:ROBERT J AMICO PT INC
Other - Org Name:FYZICAL THERAPY & BALANCE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PALUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-271-8424
Mailing Address - Street 1:418 W CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-5638
Mailing Address - Country:US
Mailing Address - Phone:574-271-8424
Mailing Address - Fax:574-271-8425
Practice Address - Street 1:7320 ASPECT DR UNIT 200
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-7765
Practice Address - Country:US
Practice Address - Phone:574-271-8424
Practice Address - Fax:574-271-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050004562A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200735280AMedicaid
IN200735280AMedicaid