Individual provider Active NPI

Elizabeth Maria Anzelmo, P.T.

  • Physical Therapist
  • Angola, IN
National Provider Identifier
1104968486
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
05004428A Issued in IN
Practice address
3270 Intertech Drive
Angola, IN 46703
Phone
(260) 668-7752
Fax
(260) 668-7552
NPI assigned
Feb 13, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 05004428A IN Primary

Addresses

Primary practice location

3270 Intertech Drive
Angola, IN 46703

Mailing address

95 Lane 650 D Snow Lake
Fremont, IN 46737
Phone (260) 833-6421

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120203000091 IN Practitioner - Physical Therapist in Private Practice 5395842066 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1992
Medicare assignment
May accept Medicare assignment
Group practices
Achieve Physical Therapy and Sports Performance LLCGroup PAC ID 8224177084, 3 clinicians

Practice addresses (Care Compare)

202 E Harcourt Rd
Suite 1400
Angola, IN 46703-7198
Phone (260) 665-7000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05004428AINMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Achieve Physical Therapy and Sports Performance, LLC Physical Therapist CurrentSince Aug 1, 2011 Accepting new patients
Angola Physical Therapy, Inc. Physical Therapist Past Accepting new patients

Locations

202 E Harcourt Rd
Ste 1400
Angola, IN 46703

202 E Harcourt Rd
Ste U
Angola, IN 46703
Phone (260) 665-7000

500 E Harcourt Rd
Angola, IN 46703
Phone (260) 665-7000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104968486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 LANE 650 D SNOW LAKE",
            "city": "FREMONT",
            "state": "IN",
            "postal_code": "46737",
            "telephone_number": "260-833-6421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3270 INTERTECH DRIVE",
            "city": "ANGOLA",
            "state": "IN",
            "postal_code": "46703",
            "telephone_number": "260-668-7752",
            "fax_number": "260-668-7552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANZELMO",
        "first_name": "ELIZABETH",
        "middle_name": "MARIA",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05004428A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Angola, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.