Provider Demographics
NPI:1124455019
Name:IFAST PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:IFAST PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:317-578-0998
Mailing Address - Street 1:9402 UPTOWN DR
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1000
Mailing Address - Country:US
Mailing Address - Phone:317-578-0998
Mailing Address - Fax:
Practice Address - Street 1:9402 UPTOWN DR
Practice Address - Street 2:SUITE 1600
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1000
Practice Address - Country:US
Practice Address - Phone:317-578-0998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty