# LAFAYETTE'S WOUND CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740531409
- **Authorized official:** MRS. KELLEY HUIZAR DPT (CEO)
- **Authorized official phone:** (765) 838-1660

## Contact information

- **Practice address:** 635 S EARL AVE, SUITE B, LAFAYETTE, IN 47904-3603
- **Practice address phone:** (765) 838-8208
- **Practice address fax:** (765) 838-8207
- **Mailing address:** 635 S EARL AVE, SUITE B, LAFAYETTE, IN 47904-3603
- **Mailing address phone:** (765) 838-8208
- **Mailing address fax:** (765) 838-8207

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |
| 213E00000X | Podiatrist | — | NULL | — |
| 213E00000X | Podiatrist | — | — | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 364S00000X | Clinical Nurse Specialist | — | NULL | — |
| 364S00000X | Clinical Nurse Specialist | — | — | — |

## Other

- **Enumeration date:** 09/20/2012
- **Last updated:** 09/20/2012