Organization
INDIANA STATE UNIVERSITY
Active
Other names
ISU Physical Therapy and Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRED LUSTER PT (INTERIM PT DIRECTOR)
(812) 237-9613
Entity
Organization
Contact information
Practice address
567 N 5TH ST., TERRE HAUTE, IN 47809
(812) 237-9613
(812) 237-9612
Mailing address
567 N 5TH ST., TERRE HAUTE, IN 47809
(812) 237-9613
(812) 237-9612
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05010420A
IN
261QP2000X
Physical Therapy Clinic/Center
05009329A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000528265
BLUECROSS & BLUE SHIELD
IN
Enumeration date
07/25/2007
Last updated
04/11/2017
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