Provider Demographics
NPI:1982881868
Name:DOWNTOWN PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:DOWNTOWN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:317-634-0600
Mailing Address - Street 1:251 N ILLINOIS ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1927
Mailing Address - Country:US
Mailing Address - Phone:317-634-0600
Mailing Address - Fax:317-634-0606
Practice Address - Street 1:251 N ILLINOIS ST
Practice Address - Street 2:SUITE 190
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1947
Practice Address - Country:US
Practice Address - Phone:317-634-0600
Practice Address - Fax:317-634-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008871A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000538629OtherANTHEM
IN255080Medicare PIN