Organization
MIDWEST SPORT & SPINE REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DUKE WADE HARTWELL PT, CERT MDT (OWNER)
(812) 342-2411
Entity
Organization
Contact information
Practice address
4420 W JONATHAN MOORE PIKE, COLUMBUS, IN 47201-4685
(812) 342-2411
(812) 342-2413
Mailing address
4420 W JONATHAN MOORE PIKE, COLUMBUS, IN 47201-4685
(812) 342-2411
(812) 342-2413
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
05008884A
IN
Other
Enumeration date
04/26/2010
Last updated
08/05/2010
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