Individual
ROBERT WAYNE LONG III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.A.
Contact information
Practice address
275 W 12TH ST, PERU, IN 46970-1638
(765) 472-8000
Mailing address
1452 STRAWTOWN PIKE, PERU, IN 46970-2775
(765) 461-3938
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06005129A
IN
Other
Enumeration date
07/25/2015
Last updated
07/25/2015
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