Organization
PORTER COUNTY PHYSICAL MED REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS LISA M HAYES (INS COORDINATOR)
(219) 548-3828
Entity
Organization
Contact information
Practice address
2600 N ROOSEVELT ROAD, STE 200 3, VALPARAISO, IN 46383-0970
(219) 548-3828
(219) 548-3803
Mailing address
2600 N ROOSEVELT ROAD, STE 200 3, VALPARAISO, IN 46383-0970
(219) 548-3828
(219) 548-3803
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05003279A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000356528
GROUP NUMBER BCBS
IN
Enumeration date
11/17/2006
Last updated
08/22/2020
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