1013204809 NPI number — MRS. ELIZABETH LESTEE GARRETT PT, DPT

Table of content: MARY BETH TINNEY MS, CCC-SLP (NPI 1992907869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013204809 NPI number — MRS. ELIZABETH LESTEE GARRETT PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARRETT
Provider First Name:
ELIZABETH
Provider Middle Name:
LESTEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013204809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12247 BRANGTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FISHERS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46037-8202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-598-9497
Provider Business Mailing Address Fax Number:
317-288-7607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7209 N SHADELAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46250-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-288-7606
Provider Business Practice Location Address Fax Number:
317-288-7607
Provider Enumeration Date:
06/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  05009050A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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