Active NPI
Maria Rose Lalyn Tan Elvinia
- Physical Therapist
- Indianapolis, IN
National Provider Identifier
1609030493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05008445A
- Practice address
- 7301 E 16TH Street
Wildwood Health Care Center
Indianapolis, IN 46219 - Phone
- (317) 353-1290
- NPI assigned
- Jul 11, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05008445A | IN | Primary |
Addresses
Primary practice location
7301 E 16TH Street
Wildwood Health Care Center
Indianapolis, IN 46219
Mailing address
3916 Wind Drift Dr E
Apt 1D
Indianapolis, IN 46254-3216
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fox Rehab Indiana LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Cherry Hill, NJ
- NPI 1043568942
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215993600000",
"number": "1609030493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3916 WIND DRIFT DR E",
"address_2": "APT 1D",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462543216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7301 E 16TH STREET",
"address_2": "WILDWOOD HEALTH CARE CENTER",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "46219",
"telephone_number": "317-353-1290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELVINIA",
"first_name": "MARIA ROSE LALYN",
"middle_name": "TAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-11",
"last_updated": "2008-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05008445A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.