Mary Ann Indorf, R.P.T.

Primary specialty

SpecialistTaxonomy code 174400000X

License

002495 Issued in CT

Practice address

93 Waterbury Rd
Prospect, CT 06712-1223

Phone

(203) 756-6569

Fax

(203) 758-0443

NPI assigned

Jun 8, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Score, LLC

  • Physical Therapist
  • Middlebury, CT
  • NPI 1891822607
  NPD (past)

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

{
    "created_epoch": "1244419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244419200000",
    "number": "1124254925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 HOLLEY LN",
            "city": "PROSPECT",
            "state": "CT",
            "postal_code": "067121484",
            "telephone_number": "203-756-6569",
            "fax_number": "203-758-0443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "93 WATERBURY RD",
            "city": "PROSPECT",
            "state": "CT",
            "postal_code": "067121223",
            "telephone_number": "203-756-6569",
            "fax_number": "203-758-0443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INDORF",
        "first_name": "MARY ANN",
        "name_prefix": "Ms.",
        "credential": "R.P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-08",
        "last_updated": "2009-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CT",
            "license": "002495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "080002495CT03",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Prospect, CT
• Specialist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2009; 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.