Provider Demographics
NPI:1255600862
Name:PROFESSIONAL STAFF MANAGEMENT
Entity type:Organization
Organization Name:PROFESSIONAL STAFF MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR FOR UPA
Authorized Official - Prefix:MR
Authorized Official - First Name:BRONSON
Authorized Official - Middle Name:
Authorized Official - Last Name:TROYER
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:317-274-2029
Mailing Address - Street 1:224 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5412
Mailing Address - Country:US
Mailing Address - Phone:765-935-1515
Mailing Address - Fax:765-962-6732
Practice Address - Street 1:705 RILEY HOSPITAL DRIVE
Practice Address - Street 2:RR127 RILEY HOSPITAL FOR CHILDREN,
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5225
Practice Address - Country:US
Practice Address - Phone:317-274-8906
Practice Address - Fax:317-274-4022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Single Specialty