Provider Demographics
NPI:1134563273
Name:ACHIEVE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ACHIEVE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORETO
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYANI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:765-453-8855
Mailing Address - Street 1:107 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-3408
Mailing Address - Country:US
Mailing Address - Phone:317-426-3477
Mailing Address - Fax:317-622-2971
Practice Address - Street 1:107 E 34TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3408
Practice Address - Country:US
Practice Address - Phone:317-426-3477
Practice Address - Fax:317-622-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
05004050A2251S0007X
IN05004058A2251X0800X, 225100000X, 225100000X
IN31001185A225XH1200X
31001185A225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN258880OtherMEDICARE PTAN