Provider Demographics
NPI:1902181233
Name:ST. JOHN THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:ST. JOHN THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CABALLES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:219-716-0030
Mailing Address - Street 1:10197 BACKWATER CV
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-7008
Mailing Address - Country:US
Mailing Address - Phone:219-750-9763
Mailing Address - Fax:
Practice Address - Street 1:9111 BROADWAY
Practice Address - Street 2:SUITE MM
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8122
Practice Address - Country:US
Practice Address - Phone:219-750-9763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006512A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty