Provider Demographics
NPI:1851335681
Name:PADUA, IVY G (PT)
Entity Type:Individual
Prefix:MISS
First Name:IVY
Middle Name:G
Last Name:PADUA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-6683
Mailing Address - Country:US
Mailing Address - Phone:812-428-6915
Mailing Address - Fax:
Practice Address - Street 1:1610 DIVISION ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-6683
Practice Address - Country:US
Practice Address - Phone:812-428-6915
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008903A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist