Provider Demographics
NPI:1821540030
Name:ST MARY'S THERAPY NORTHSIDE
Entity Type:Organization
Organization Name:ST MARY'S THERAPY NORTHSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BINHACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-469-4770
Mailing Address - Street 1:14020 OLD STATE RD STE D100
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-1164
Mailing Address - Country:US
Mailing Address - Phone:812-469-4770
Mailing Address - Fax:812-469-4794
Practice Address - Street 1:14020 OLD STATE RD STE D100
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-1164
Practice Address - Country:US
Practice Address - Phone:812-469-4770
Practice Address - Fax:812-469-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001428A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy