Organization
BRAZIL PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. M'LISSA S HALDT RPT (OWNER/RPT)
(812) 443-6144
Entity
Organization
Contact information
Practice address
117 S WALNUT ST, BRAZIL, IN 47834-2622
(812) 443-6144
(812) 443-5506
Mailing address
PO BOX 563, BRAZIL, IN 47834-0563
(812) 443-6144
(812) 443-5506
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05002542
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000255594
BCBS
IN
01
—
DC9253
PALMETTO GBA
IN
Enumeration date
02/22/2008
Last updated
02/22/2008
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