Provider Demographics
NPI:1750632006
Name:ELDERCARE THERAPY SPECIALISTS LLC
Entity Type:Organization
Organization Name:ELDERCARE THERAPY SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BIDUR
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKHERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:317-540-0285
Mailing Address - Street 1:11867 BELLHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-6684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11867 BELLHAVEN DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-6684
Practice Address - Country:US
Practice Address - Phone:317-219-3412
Practice Address - Fax:317-219-3889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010183A225100000X
IN31004910A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty