Provider Demographics
NPI:1770702441
Name:PHYSIOTHERAPY ASSOCIATES INC
Entity type:Organization
Organization Name:PHYSIOTHERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIGENFUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-685-7227
Mailing Address - Street 1:1781 E LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3993
Mailing Address - Country:US
Mailing Address - Phone:765-864-0696
Mailing Address - Fax:765-864-0686
Practice Address - Street 1:1781 E LINCOLN RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3993
Practice Address - Country:US
Practice Address - Phone:765-864-0696
Practice Address - Fax:765-864-0686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5387109OtherAETNA
IN000000511099OtherBCBS
IN000000511099OtherBCBS