Provider Demographics
NPI:1548356090
Name:PLOSKI, MICHAEL R (PT, ATC, OCS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:PLOSKI
Suffix:
Gender:M
Credentials:PT, ATC, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 E. 75TH ST.
Mailing Address - Street 2:SUITE 116
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2717
Mailing Address - Country:US
Mailing Address - Phone:317-577-9338
Mailing Address - Fax:317-577-0422
Practice Address - Street 1:6330 E. 75TH ST.
Practice Address - Street 2:SUITE 116
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2717
Practice Address - Country:US
Practice Address - Phone:317-577-9338
Practice Address - Fax:317-577-0422
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002978A2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000175262OtherANTHEM
IN156529Medicare ID - Type Unspecified