Organization
INDY PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETE C MANZELLI (OWNER/MPT)
(317) 849-3517
Entity
Organization
Contact information
Practice address
5250 E US HIGHWAY 36, STE 420, AVON, IN 46123-9199
(317) 849-3517
(317) 849-6397
Mailing address
5250 E US HIGHWAY 36, STE 420, AVON, IN 46123-9199
(317) 849-3517
(317) 849-6397
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
53000103A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000505369
ANTHEM/BCBS
IN
Enumeration date
07/20/2007
Last updated
11/27/2007
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