1811303399 NPI number — RCA PHYSICAL THERAPY, INC

Table of content: (NPI 1811303399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811303399 NPI number — RCA PHYSICAL THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RCA PHYSICAL THERAPY, INC
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:
1811303399
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10644
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRILLVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46411-0644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-525-4176
Provider Business Mailing Address Fax Number:
219-750-9451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8691 CONNECTICUT ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-5541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-525-4176
Provider Business Practice Location Address Fax Number:
219-472-0841
Provider Enumeration Date:
07/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ADISA
Authorized Official First Name:
FATAI
Authorized Official Middle Name:
BOLAJI
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
219-313-0763

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 225100000X . This is a "TAXONOMY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1710930011 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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