Organization
REQUEST PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY COOK (CEO)
(765) 649-5564
Entity
Organization
Contact information
Practice address
4018 COLUMBUS AVE, ANDERSON, IN 46013-5010
(765) 649-5564
(765) 641-7607
Mailing address
4018 COLUMBUS AVE, ANDERSON, IN 46013-5010
(765) 649-5564
(765) 641-7607
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000222166
ANTHEM
IN
Enumeration date
05/10/2006
Last updated
12/05/2007
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