Physiocare Homecare LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PHYSIOCARE HOMECARE LLC

Practice address

625 S Earl Ave Ste D
Lafayette, IN 47904-3602

Phone

(765) 838-1660

Fax

(765) 838-1662

NPI assigned

Jul 1, 2020

Last updated

Jul 1, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelley Manzon Gray, MBA, DPT

Title

Administrator

Phone

(765) 868-1660

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1593561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593561600000",
    "number": "1003433566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 S EARL AVE STE D",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479043602",
            "telephone_number": "765-838-1660",
            "fax_number": "765-838-1662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 S EARL AVE STE D",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479043602",
            "telephone_number": "765-838-1660",
            "fax_number": "765-838-1662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSIOCARE HOMECARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-01",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A",
        "authorized_official_last_name": "MANZON GRAY",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "765-868-1660",
        "authorized_official_credential": "MBA, DPT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.