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Individual
TY A CHILDERS
Active
Individual
TY A CHILDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05010631A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540922
MEDICARE PTAN
IN
05
—
201308360
—
IN
Enumeration date
01/14/2013
Last updated
02/09/2024
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