Organization
SOUTHERN INDIANA MYOFASCIAL RELEASE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA JEAN PARDY OTR/L (OWNER)
(812) 788-1118
Entity
Organization
Contact information
Practice address
101 NW 1ST ST STE D, PAOLI, IN 47454-1369
(812) 788-1118
Mailing address
101 NW 1ST ST STE D, PAOLI, IN 47454-1369
(812) 788-1118
(888) 371-6163
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
31005499A
IN
Other
Enumeration date
08/13/2014
Last updated
11/02/2019
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