Elizabeth Maria Anzelmo, P.T. – Physical Therapist

Key facts

NPI: 1104968486
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapist 225100000X
License: 05004428A (IN)
Practice address: 3270 Intertech Drive
Angola, IN 46703
Phone: (260) 668-7752
Fax: (260) 668-7552
NPI assigned: Feb 13, 2007
Sex: Female
Sole proprietor: No

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 and National Provider Directory roles.

Achieve Physical Therapy and Sports Performance, LLC Specialist · Angola, IN · NPI 1053646646

Medicare reassignment Care Compare group NPD IN · PHYSICAL THERAPIST
Angola Physical Therapy, Inc. Physical Therapist · Angola, IN · NPI 1588721005

NPD (past) PHYSICAL THERAPIST

Medicare Care Compare profile

Specialty: Physical Therapist in Private Practice
Education: Other, 1992
Medicare assignment: May accept Medicare assignment
Group practices: Achieve Physical Therapy and Sports Performance LLC (3 clinicians)

Practice addresses (Care Compare)

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

Medicare participation

Medicare fee-for-service enrollment: Enrolled in IN

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20120203000091	IN	Practitioner - Physical Therapist in Private Practice	5395842066	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
Achieve Physical Therapy and Sports Performance, LLC	Physical Therapist	Current since Aug 1, 2011	Accepting new patients
Angola Physical Therapy, Inc.	Physical Therapist	Past	Accepting new patients

Locations

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

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

202 E Harcourt Rd
Ste 1400
Angola, IN 46703

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapist	225100000X	05004428A	IN	Yes

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "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

All providers in Angola, IN · Physical Therapist in Indiana

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (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.