Provider Demographics
NPI:1134564404
Name:RELIANCE PHYSICAL THERAPY AND WELLNESS CENTER INC
Entity type:Organization
Organization Name:RELIANCE PHYSICAL THERAPY AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLUMBUS
Authorized Official - Middle Name:O
Authorized Official - Last Name:MBACHU
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:219-769-6037
Mailing Address - Street 1:300 W 80TH PL STE D
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5476
Mailing Address - Country:US
Mailing Address - Phone:219-769-6037
Mailing Address - Fax:219-769-6113
Practice Address - Street 1:300 W 80TH PL STE D
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5476
Practice Address - Country:US
Practice Address - Phone:219-769-6037
Practice Address - Fax:219-769-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004975A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy