Indiana Physical Therapy, Inc.

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

INDIANA PHYSICAL THERAPY, INC.

Practice address

3300 Lake City Hwy.
Warsaw, IN 46580

Phone

(574) 306-2912

Fax

(574) 306-2922

NPI assigned

Dec 9, 2014

Organization subpart

Yes

Parent organization

INDIANA PHYSICAL THERAPY, INC.As reported in NPPES

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

Authorized official

Name

Dru Nichole Bishop

Title

Credentialing Specialist

Phone

(260) 432-4700

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Outpatient physical therapy / speech pathology certification: CCN 156646

Legal name

INDIANA PHYSICAL THERAPY, INC

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Sep 7, 2016

Last certification

Sep 7, 2016

Ownership / control type

Proprietary

Facility address

3300 Lake City Highway
Warsaw, IN 46580

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Indiana Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Bluffton, IN
  • NPI 1629110192

  5496663247

  Same PAC ID
• Indiana Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Elkhart, IN
  • NPI 1427535749

  5496663247

  Same PAC ID
• Indiana Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Indianapolis, IN
  • NPI 1427614452

  5496663247

  Same PAC ID
• Indiana Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Angola, IN
  • NPI 1780726257

  5496663247

  Same PAC ID

Tax ID family

Indiana Physical Therap6 organizations share this tax ID, including this one

Part of

Indiana Physical Therap

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

• Indiana Physical Therapy Inc

  • Public Health or Welfare Agency
  • Fort Wayne, IN
  • NPI 1841534914
  NPD tax ID
• Indiana Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Fort Wayne, IN
  • NPI 1992101638
  NPD tax ID
• Indiana Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Elkhart, IN
  • NPI 1427535749
  NPD tax ID
• Indiana Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Indianapolis, IN
  • NPI 1427614452
  NPD tax ID
• Indiana Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Angola, IN
  • NPI 1780726257
  NPD tax ID

Locations

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

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1306244231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4251 LAHMEYER RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46815",
            "telephone_number": "260-432-4700",
            "fax_number": "260-459-9262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 LAKE CITY HWY.",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "46580",
            "telephone_number": "574-306-2912",
            "fax_number": "574-306-2922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA PHYSICAL THERAPY, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDIANA PHYSICAL THERAPY, INC.",
        "enumeration_date": "2014-12-09",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A",
        "authorized_official_last_name": "BISHOP",
        "authorized_official_first_name": "DRU",
        "authorized_official_middle_name": "NICHOLE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "260-432-4700"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Erin Hunter, M.A.
• Ha Kang Hwang
• Jessica A Iden, COTA
• Patrick B. Ilada, MD
• Nilanka Rurangi Silva Inasi, MA
• Dominique Islas
• Jace Medical LLC
• Elizabeth Ann Jackson, COTA
• Kieran L. Jackson, MSW
• Andrew Paul Jankowski

• Physical Therapy Clinic/Center in Warsaw, IN
• Providers in Warsaw, IN by specialty
• Physical Therapy Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.