Provider Demographics
NPI:1356051593
Name:INSIDE TRACK PHYSICAL THERAPY & WELLNESS
Entity type:Organization
Organization Name:INSIDE TRACK PHYSICAL THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:RAE STACK
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:574-971-1815
Mailing Address - Street 1:215 CARTER RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-5203
Mailing Address - Country:US
Mailing Address - Phone:574-971-1815
Mailing Address - Fax:
Practice Address - Street 1:1400 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4488
Practice Address - Country:US
Practice Address - Phone:574-971-1815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy