Provider Demographics
NPI:1821397779
Name:AVON PHYSICAL MEDICINE INC
Entity Type:Organization
Organization Name:AVON PHYSICAL MEDICINE INC
Other - Org Name:HEALTH1ST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOLLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-683-1971
Mailing Address - Street 1:1420 SADLIER CIRCLE E DRIVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239
Mailing Address - Country:US
Mailing Address - Phone:317-683-1972
Mailing Address - Fax:317-683-1989
Practice Address - Street 1:8258 ROCKVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214
Practice Address - Country:US
Practice Address - Phone:317-429-5400
Practice Address - Fax:317-429-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty