Provider Demographics
NPI:1831245869
Name:BIANCARDI, MICHAELA M (PT)
Entity type:Individual
Prefix:MS
First Name:MICHAELA
Middle Name:M
Last Name:BIANCARDI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:FELUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6504 E 129TH AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9087
Mailing Address - Country:US
Mailing Address - Phone:219-662-7654
Mailing Address - Fax:219-662-2136
Practice Address - Street 1:1595 S CALUMET RD STE 3
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2389
Practice Address - Country:US
Practice Address - Phone:192-764-4888
Practice Address - Fax:219-898-4258
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007062A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12114004OtherCAQH
IN000000198740OtherANTHEM
IN200642800OtherFIRST STEPS
IN300034647Medicaid