Provider Demographics
NPI:1427233931
Name:PHYSICAL THERAPY/E.T.C.
Entity type:Organization
Organization Name:PHYSICAL THERAPY/E.T.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:219-322-2624
Mailing Address - Street 1:PO BOX 1778
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-0778
Mailing Address - Country:US
Mailing Address - Phone:219-322-2624
Mailing Address - Fax:219-864-0428
Practice Address - Street 1:2121 NORTHWINDS DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1882
Practice Address - Country:US
Practice Address - Phone:219-322-2624
Practice Address - Fax:219-864-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05000420A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000089040OtherANTHEM BC/BS
IN201190Medicare PIN