Individual
TAYLOR GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA, BS, CPT, CEP
Contact information
Practice address
5515 W 38TH ST, INDIANAPOLIS, IN 46254-2995
(317) 880-0280
(317) 880-0296
Mailing address
115 CONRADT AVE, KOKOMO, IN 46901-5253
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06006868A
IN
Other
Enumeration date
10/04/2024
Last updated
10/04/2024
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