Provider Demographics
NPI:1548682537
Name:TAI LLC
Entity type:Organization
Organization Name:TAI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHANNES
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:812-972-7724
Mailing Address - Street 1:5140 CHARLESTOWN RD
Mailing Address - Street 2:SUIT 1A
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9475
Mailing Address - Country:US
Mailing Address - Phone:812-972-7724
Mailing Address - Fax:812-572-4696
Practice Address - Street 1:5140 CHARLESTOWN RD
Practice Address - Street 2:SUIT 1A
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9475
Practice Address - Country:US
Practice Address - Phone:812-972-7724
Practice Address - Fax:812-572-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003469A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty