Provider Demographics
NPI:1760622815
Name:ABC THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:ABC THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE RAYMUNDO
Authorized Official - Middle Name:SORIO
Authorized Official - Last Name:CATRAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:574-272-2240
Mailing Address - Street 1:12655 SR 23
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9641
Mailing Address - Country:US
Mailing Address - Phone:574-272-2240
Mailing Address - Fax:574-272-2252
Practice Address - Street 1:12655 STATE ROAD 23
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9641
Practice Address - Country:US
Practice Address - Phone:574-272-2240
Practice Address - Fax:574-272-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
258440OtherMEDICARE PTAN
IN200918300 AMedicaid