Organization
TOTAL LIFE PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA M MARTIN PT (OWNER)
(812) 883-5454
Entity
Organization
Contact information
Practice address
5 PUBLIC SQ, SALEM, IN 47167-2050
(812) 883-5454
(812) 883-6464
Mailing address
PO BOX 425, SALEM, IN 47167-0425
(812) 883-5454
(812) 883-6464
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
05008539A
IN
261QP2000X
Physical Therapy Clinic/Center
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000535153
ANTHEM BC/BS
IN
01
—
0007714984
AETNA
IN
01
—
089937
SIHO
IN
01
—
11775364
CAQH
IN
01
—
1841335056
NPI
IN
01
—
38856
IHN
IN
Enumeration date
06/19/2007
Last updated
04/20/2008
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