Organization
PEDIATRIC REHABILITATION OF INDIANA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN CALDECOTT DIETERICH MD (OWNER)
(361) 548-5270
Entity
Organization
Contact information
Practice address
3825 N MERIDIAN ST, INDIANAPOLIS, IN 46208-4018
(361) 548-5270
Mailing address
5006 DEER PARK CIR, CORPUS CHRISTI, TX 78413-6027
(361) 548-5270
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
01043182A
IN
Other
Enumeration date
05/20/2007
Last updated
08/22/2020
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