Organization
PHYSIOCARE HOMECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLEY MANZON GRAY MBA, DPT (ADMINISTRATOR)
(765) 868-1660
Entity
Organization
Contact information
Practice address
625 S EARL AVE STE D, LAFAYETTE, IN 47904-3602
(765) 838-1660
(765) 838-1662
Mailing address
625 S EARL AVE STE D, LAFAYETTE, IN 47904-3602
(765) 838-1660
(765) 838-1662
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
07/01/2020
Last updated
07/01/2020
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