Individual
SHANE TOLBERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
5949 W RAYMOND ST, INDIANAPOLIS, IN 46241-4348
(317) 390-5575
(317) 486-2189
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05007793A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000231495
ANTHEM ID
IN
05
—
200399560
—
IN
Enumeration date
03/31/2006
Last updated
01/11/2012
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