Provider Demographics
NPI:1902893621
Name:INDY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:INDY PHYSICAL THERAPY
Other - Org Name:INDY PHYSIOTHERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:EL BARIDI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:317-849-3517
Mailing Address - Street 1:PO BOX 50370
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-0370
Mailing Address - Country:US
Mailing Address - Phone:317-849-3517
Mailing Address - Fax:317-849-6397
Practice Address - Street 1:7950 N SHADELAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2691
Practice Address - Country:US
Practice Address - Phone:317-849-3517
Practice Address - Fax:317-849-6397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005794A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000282200OtherANTHEM ID NUMBER
IN200940Medicare ID - Type UnspecifiedMEDICARE ID NUMBER