Individual
JOHN EDWARD LAFREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT ATC
Contact information
Practice address
2934 MILLER DR, PLYMOUTH, IN 46563-8083
(574) 941-2200
(574) 941-2206
Mailing address
2934 MILLER DR, PLYMOUTH, IN 46563-8083
(574) 941-2200
(574) 941-2206
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05004435A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000215756
ANTHEM PROVIDER NUMBER
IN
Enumeration date
07/21/2005
Last updated
05/29/2009
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