Provider Demographics
NPI:1922330380
Name:HUSSEY, MINDY S
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:S
Last Name:HUSSEY
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 1:1851 W 975 S
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT
Mailing Address - State:IN
Mailing Address - Zip Code:46928-9726
Mailing Address - Country:US
Mailing Address - Phone:765-620-7686
Mailing Address - Fax:765-948-4670
Practice Address - Street 1:1851 W 975 S
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT
Practice Address - State:IN
Practice Address - Zip Code:46928-9726
Practice Address - Country:US
Practice Address - Phone:765-620-7686
Practice Address - Fax:765-948-4670
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007969A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist