1528403714 NPI number — HEALTH REACH PHYSICAL THERAPY P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528403714 NPI number — HEALTH REACH PHYSICAL THERAPY P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH REACH PHYSICAL THERAPY P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1528403714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9200 CALUMET AVE
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
MUNSTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46321-2885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-513-8866
Provider Business Mailing Address Fax Number:
219-513-8835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9200 CALUMET AVE
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321-2885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-513-8866
Provider Business Practice Location Address Fax Number:
219-513-8835
Provider Enumeration Date:
05/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ABDALLAH
Authorized Official First Name:
MAZOZA
Authorized Official Middle Name:
MORSI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
219-513-8866

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  05004041A , 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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