Individual
HENRICO MARC ENVERGA MADRID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BSPT
Contact information
Practice address
904 E 11TH ST, RUSHVILLE, IN 46173-1368
(765) 932-2974
Mailing address
7443 HARTINGTON PL, INDIANAPOLIS, IN 46259-5805
(317) 862-1490
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05008201A
IN
Other
Enumeration date
12/19/2012
Last updated
12/19/2012
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