Provider Demographics
NPI:1295962736
Name:HEALTH 1ST PHYSICAL REHABILITATION OF INDIANAPOLIS INC
Entity type:Organization
Organization Name:HEALTH 1ST PHYSICAL REHABILITATION OF INDIANAPOLIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DPT, RN
Authorized Official - Phone:317-253-1644
Mailing Address - Street 1:6326 RUCKER RD STE F
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4861
Mailing Address - Country:US
Mailing Address - Phone:317-253-1644
Mailing Address - Fax:317-253-9708
Practice Address - Street 1:6326 RUCKER RD STE F
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4861
Practice Address - Country:US
Practice Address - Phone:317-253-1644
Practice Address - Fax:317-253-9708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 291U00000X, 332B00000X
IN28195910A163W00000X
IN01043420A207LP2900X
IN05010034A225100000X
IN71002983A363LF0000X
IN08001746A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN168840Medicare PIN