Active NPI
Gisou Behrouzi, RPT., DPT
- Physical Therapist
- Vincennes, IN
National Provider Identifier
1730430570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05005665A
- Practice address
- 3801 Old Bruceville Rd
Vincennes, IN 47591-3889 - Phone
- (812) 886-4677
- Fax
- (812) 886-4678
- NPI assigned
- Sep 19, 2012
- 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 | 05005665A | IN | Primary |
Addresses
Primary practice location
3801 Old Bruceville Rd
Vincennes, IN 47591-3889
Mailing address
501 S Brook Ave
Mishawaka, IN 46544-3405
Phone (574) 850-8710
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05005665A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348012800000",
"number": "1730430570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 S BROOK AVE",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465443405",
"telephone_number": "574-850-8710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3801 OLD BRUCEVILLE RD",
"city": "VINCENNES",
"state": "IN",
"postal_code": "475913889",
"telephone_number": "812-886-4677",
"fax_number": "812-886-4678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEHROUZI",
"first_name": "GISOU",
"name_prefix": "Dr.",
"credential": "RPT., DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-19",
"last_updated": "2012-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05005665A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vincennes, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.