Active NPI
Tanya Fondekar
- Physical Therapist
- Peru, IN
National Provider Identifier
1679934764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05011795A
- Practice address
- 275 W 12TH St
4 West
Peru, IN 46970-1638 - Phone
- (765) 475-2160
- Fax
- (765) 475-2164
- NPI assigned
- Mar 16, 2016
- Sex
- Female
- Sole proprietor
- No
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 | 05011795A | IN | Primary |
Addresses
Primary practice location
275 W 12TH St
4 West
Peru, IN 46970-1638
Mailing address
1800 N Wabash Rd Ste 203
Marion, IN 46952-1300
Phone (765) 651-3229
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05011795A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458086400000",
"number": "1679934764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 N WABASH RD STE 203",
"city": "MARION",
"state": "IN",
"postal_code": "469521300",
"telephone_number": "765-651-3229",
"fax_number": "765-651-3227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 W 12TH ST",
"address_2": "4 WEST",
"city": "PERU",
"state": "IN",
"postal_code": "469701638",
"telephone_number": "765-475-2160",
"fax_number": "765-475-2164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONDEKAR",
"first_name": "TANYA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-16",
"last_updated": "2016-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05011795A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peru, IN
- Rafik Farag, MD
- Margaret Farley Farley, LMHC
- Patricia Flores, DDS
- Bethany Foerg, LMFTA
- Emily Renee Foley, PHARMD
- Fort Wayne Orthopedics, LLC
- Four County Comprehensive Mental Health Center Inc
- Four County Comprehensive Mental Health Center Inc
- Four County Comprehensive Mental Health Center, Inc
- David Allen Franklin, MSPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.