Provider Demographics
NPI:1720133259
Name:PHYSICAL THERAPY IN YOUR HOME INDIANA
Entity Type:Organization
Organization Name:PHYSICAL THERAPY IN YOUR HOME INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-189-2105
Mailing Address - Street 1:400 S DIXIE HWY
Mailing Address - Street 2:120
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5518
Mailing Address - Country:US
Mailing Address - Phone:561-368-3472
Mailing Address - Fax:561-750-6849
Practice Address - Street 1:400 S DIXIE HWY
Practice Address - Street 2:120
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5518
Practice Address - Country:US
Practice Address - Phone:561-368-3472
Practice Address - Fax:561-750-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005132A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty