Provider Demographics
NPI:1538211578
Name:INDY PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:INDY PHYSICAL THERAPY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MANZELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:317-849-3517
Mailing Address - Street 1:7950 N SHADELAND AVE
Mailing Address - Street 2:#200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2691
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:#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?:Yes
Parent Organization LBN:INDY PHYSICAL THERAPY, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006219A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000505369OtherANTHEM/BCBS
IN000000505369OtherANTHEM/BCBS