Provider Demographics
NPI:1932118593
Name:HOOSIER PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:HOOSIER PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:BARILE
Authorized Official - Suffix:
Authorized Official - Credentials:DC,PT
Authorized Official - Phone:260-420-4400
Mailing Address - Street 1:PO BOX 350034
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43635-0034
Mailing Address - Country:US
Mailing Address - Phone:260-420-4400
Mailing Address - Fax:260-420-4448
Practice Address - Street 1:3030 LAKE AVE
Practice Address - Street 2:SUITE 26
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5428
Practice Address - Country:US
Practice Address - Phone:260-420-4400
Practice Address - Fax:260-420-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN53000059A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200250170AMedicaid
IN200250170BMedicaid
IN200250170AMedicaid
IN145240Medicare PIN