Provider Demographics
NPI:1235335985
Name:INDY PHYSICAL THERAPY
Entity type:Organization
Organization Name:INDY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:317-849-3517
Mailing Address - Street 1:PO BOX 50370
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-0370
Mailing Address - Country:US
Mailing Address - Phone:317-849-3517
Mailing Address - Fax:317-849-6397
Practice Address - Street 1:831 BROAD RIPPLE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1960
Practice Address - Country:US
Practice Address - Phone:317-849-3517
Practice Address - Fax:317-849-6397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000505369OtherANTHEM/BCBS
IN248320Medicare ID - Type Unspecified