Individual
MS. SUSAN DRISCOLE VINICOR
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
6301 N KEYSTONE AVE, INDIANAPOLIS, IN 46220-2156
(317) 257-2225
(317) 257-0646
Mailing address
6301 N KEYSTONE AVE, INDIANAPOLIS, IN 46220-2156
(317) 257-2225
(317) 257-0646
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05000347A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000182806
ANTHEM BC/BS
IN
01
—
5995528
AETNA
IN
Enumeration date
01/04/2006
Last updated
07/08/2007
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