Provider Demographics
NPI:1801192885
Name:BLEY, MIA
Entity Type:Individual
Prefix:MRS
First Name:MIA
Middle Name:
Last Name:BLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10059 N COUNTY ROAD 75 E
Mailing Address - Street 2:
Mailing Address - City:LIZTON
Mailing Address - State:IN
Mailing Address - Zip Code:46149-9319
Mailing Address - Country:US
Mailing Address - Phone:317-994-5533
Mailing Address - Fax:
Practice Address - Street 1:1010 HORNADAY RD
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1972
Practice Address - Country:US
Practice Address - Phone:317-852-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002720A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant