Individual
PAULA MARIE ENYEART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
7930 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 432-5800
(260) 432-9555
Mailing address
4251 LAHMEYER RD, FORT WAYNE, IN 46815-5676
(260) 432-4700
(260) 459-9262
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05010052A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100257920
MEDICAID - GROUP
IN
01
—
156546
MEDICARE - GROUP
IN
05
—
200965280A
—
IN
Enumeration date
11/17/2009
Last updated
05/16/2011
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