Individual
MARIA ROSE LALYN TAN ELVINIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7301 E 16TH STREET, WILDWOOD HEALTH CARE CENTER, INDIANAPOLIS, IN 46219
(317) 353-1290
Mailing address
3916 WIND DRIFT DR E, APT 1D, INDIANAPOLIS, IN 46254-3216
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05008445A
IN
Other
Enumeration date
07/11/2008
Last updated
07/14/2008
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