Provider Demographics
NPI:1972075281
Name:GREAT HEIGHTS PHYSICAL THERAPY
Entity type:Organization
Organization Name:GREAT HEIGHTS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, HPCS
Authorized Official - Phone:812-216-7086
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:WEST BADEN SPRINGS
Mailing Address - State:IN
Mailing Address - Zip Code:47469-0294
Mailing Address - Country:US
Mailing Address - Phone:812-216-7086
Mailing Address - Fax:812-936-7776
Practice Address - Street 1:1077 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-8469
Practice Address - Country:US
Practice Address - Phone:812-216-7086
Practice Address - Fax:812-936-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty