Provider Demographics
NPI:1700911815
Name:HOOSIER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:HOOSIER PHYSICAL THERAPY
Other - Org Name:KENDALLVILLE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARILE
Authorized Official - Suffix:
Authorized Official - Credentials:DC,PT
Authorized Official - Phone:260-420-4400
Mailing Address - Street 1:621 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-1009
Mailing Address - Country:US
Mailing Address - Phone:260-343-0343
Mailing Address - Fax:
Practice Address - Street 1:621 W NORTH ST
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-1009
Practice Address - Country:US
Practice Address - Phone:260-343-0343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN145240Medicare ID - Type Unspecified